
<!DOCTYPE html
  PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<html>
   <head>
      <meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
   <script src="../../support/js/tree.js" type="text/javascript"></script><script src="../../support/js/setTopFrameText.js" type="text/javascript"></script><script src="../../support/js/swapcss.js" type="text/javascript"></script><script type="text/javascript">
			if (find('heading')) setHeadingTextFromFileName(document.location.href);
			</script><title>HL7 Clinical Document Architecture, Release 2.0</title>
      <link rel="stylesheet" type="text/css" href="../../support/css/v3m.css" title="v3m">
      <link rel="alternate stylesheet" type="text/css" href="../../support/css/v3mviewedits.css" title="v3mviewedits">
   </head>
   <body>
      <div class="section">
         <p>
            <div id="csslinks"><a href="#" name="v3mviewedits" onclick="setActiveStyleSheet('v3mviewedits'); return false;">View Revision Marks</a><a href="#" name="v3m" onclick="setActiveStyleSheet('v3m'); return false;">Hide Revision Marks</a></div>
         </p>
         <h1>HL7 Clinical Document Architecture, Release 2.0</h1>
         <table cellspacing="0" cellpadding="3" border="1">
            <tr>
               <td align="center"><img src="../../support/graphics/ansilogo.gif" alt="Ansi"><br>ANSI/HL7 CDA, R2-2005<br>4/21/2005<img width="5" src="../../support/graphics/spacer.gif"></td>
            </tr>
         </table>
         <table border="0" width="100%" cellpadding="6">
            <tr>
               <td width="225" valign="top" align="left" nowrap>Chair/Editor</td>
               <td width="95%" valign="top" align="left" nowrap>Robert H. Dolin, MD<br><a href="mailto:Robert.H.Dolin@kp.org">Robert.H.Dolin@kp.org</a><br>Kaiser Permanente
               </td>
            </tr>
            <tr>
               <td width="225" valign="top" align="left" nowrap>Chair/Editor</td>
               <td width="95%" valign="top" align="left" nowrap>Liora Alschuler<br><a href="mailto:Liora@The-Word-Electric.com">Liora@The-Word-Electric.com</a><br>alschuler.spinosa
               </td>
            </tr>
            <tr>
               <td width="225" valign="top" align="left" nowrap>Chair/Editor</td>
               <td width="95%" valign="top" align="left" nowrap>Sandy Boyer, BSP<br><a href="mailto:slboyer@attglobal.net">slboyer@attglobal.net</a><br>Consultant
               </td>
            </tr>
            <tr>
               <td width="225" valign="top" align="left" nowrap>Chair/Editor</td>
               <td width="95%" valign="top" align="left" nowrap>Calvin Beebe<br><a href="mailto:cbeebe@mayo.edu">cbeebe@mayo.edu</a><br>Mayo Clinic
               </td>
            </tr>
            <tr>
               <td width="225" valign="top" align="left" nowrap>Editor</td>
               <td width="95%" valign="top" align="left" nowrap>Fred M. Behlen, PhD<br><a href="mailto:fbehlen@laitek.com">fbehlen@laitek.com</a><br>American College of Radiology
               </td>
            </tr>
            <tr>
               <td width="225" valign="top" align="left" nowrap>Editor</td>
               <td width="95%" valign="top" align="left" nowrap>Paul V. Biron<br><a href="mailto:Paul.V.Biron@kp.org">Paul.V.Biron@kp.org</a><br>Kaiser Permanente
               </td>
            </tr>
            <tr>
               <td width="225" valign="top" align="left" nowrap>Editor</td>
               <td width="95%" valign="top" align="left" nowrap>Amnon Shabo (Shvo), PhD<br><a href="mailto:SHABO@il.ibm.com">SHABO@il.ibm.com</a><br>IBM Research Lab in Haifa
               </td>
            </tr>
         </table>
         <p class="copyright">Last Published:&nbsp;08/02/2006&nbsp;8:17&nbsp;PM</p>
         <p class="copyright">HL7&reg; Version 3 Standard, &copy; 2006 Health 
            Level Seven&reg;, Inc.  All Rights Reserved.
         </p>
         <p class="copyright">HL7 and Health Level Seven are registered 
            trademarks of Health Level Seven, Inc.  Reg. U.S. Pat &amp; TM Off
         </p>
         <hr title="Separator for header">
         <div class="body">
            <div class="foundationtoc">
               <h2><a name="contents">Table of Contents</a></h2>
               
               <div class="toc1">1 &nbsp;<a href="#CDA_Overview">CDA Overview</a></div>
               <div class="toc2">1.1 &nbsp;<a href="#What_is_the_CDA">What is the CDA</a></div>
               <div class="toc3">1.1.1 &nbsp;<a href="#Key_aspects_of_the_CDA">Key aspects of the CDA</a></div>
               <div class="toc3">1.1.2 &nbsp;<a href="#Scope_of_the_CDA">Scope of the CDA</a></div>
               <div class="toc3">1.1.3 &nbsp;<a href="#Goals_and_Design_Principles">Goals and Design Principles</a></div>
               <div class="toc2">1.2 &nbsp;<a href="#General_CDA_Concepts">General CDA Concepts</a></div>
               <div class="toc3">1.2.1 &nbsp;<a href="#Major_Components_of_a_CDA_Document">Major Components of a CDA Document</a></div>
               <div class="toc3">1.2.2 &nbsp;<a href="#The_A_in_CDA">The "A" in "CDA"</a></div>
               <div class="toc3">1.2.3 &nbsp;<a href="#Human_Readability_and_Rendering_CDA_Documents">Human Readability and Rendering CDA Documents</a></div>
               <div class="toc3">1.2.4 &nbsp;<a href="#XML_Markup_of_CDA_Documents">XML Markup of CDA Documents</a></div>
               <div class="toc3">1.2.5 &nbsp;<a href="#Security_Confidentiality_and_Data_Integrity">Security, Confidentiality, and Data Integrity</a></div>
               <div class="toc3">1.2.6 &nbsp;<a href="#Relationship_of_the_CDA_to_HL7_Messaging_Standards">Relationship of the CDA to HL7 Messaging Standards</a></div>
               <div class="toc2">1.3 &nbsp;<a href="#CDA_Conformance">CDA Conformance</a></div>
               <div class="toc3">1.3.1 &nbsp;<a href="#Recipient_Responsibilities">Recipient Responsibilities</a></div>
               <div class="toc3">1.3.2 &nbsp;<a href="#Originator_Responsibilities">Originator Responsibilities</a></div>
               <div class="toc2">1.4 &nbsp;<a href="#CDA_Extensibility">CDA Extensibility</a></div>
               <div class="toc2">1.5 &nbsp;<a href="#Backwards_and_Forwards_Compatibility">Backwards and Forwards Compatibility</a></div>
               
               <div class="toc1">2 &nbsp;<a href="#Introduction_to_CDA_Technical_Artifacts">Introduction to CDA Technical Artifacts</a></div>
               <div class="toc2">2.1 &nbsp;<a href="#HL7_Reference_Information_Model">HL7 Reference Information Model</a></div>
               <div class="toc2">2.2 &nbsp;<a href="#HL7_V3_Data_Types">HL7 V3 Data Types</a></div>
               <div class="toc2">2.3 &nbsp;<a href="#HL7_Vocabulary_Domains">HL7 Vocabulary Domains</a></div>
               <div class="toc2">2.4 &nbsp;<a href="#HL7_CDA_RMIM">HL7 CDA R-MIM</a></div>
               <div class="toc2">2.5 &nbsp;<a href="#HL7_CDA_Hierarchical_Description">HL7 CDA Hierarchical Description</a></div>
               <div class="toc2">2.6 &nbsp;<a href="#HL7_CDA_Schema">HL7 CDA XML Implementation</a></div>
               
               <div class="toc1">3 &nbsp;<a href="#CDA_Document_Exchange_in_HL7_Messages">CDA Document Exchange in HL7 Messages</a></div>
               
               <div class="toc1">4 &nbsp;<a href="#CDA_RMIM">CDA R-MIM</a></div>
               <div class="toc2">4.1 &nbsp;<a href="#Clinical_Document">Clinical Document</a></div>
               <div class="toc2">4.2 &nbsp;<a href="#CDA_Header">Header</a></div>
               <div class="toc3">4.2.1 &nbsp;<a href="#CDA_Header_Attributes">Header Attributes</a></div>
               <div class="toc3">4.2.2 &nbsp;<a href="#CDA_Header_Participants">Header Participants</a></div>
               <div class="toc3">4.2.3 &nbsp;<a href="#CDA_Header_Relationships">Header Relationships</a></div>
               <div class="toc2">4.3 &nbsp;<a href="#CDA_Body">Body</a></div>
               <div class="toc3">4.3.1 &nbsp;<a href="#CDA_Body_Choice">Body Choice</a></div>
               <div class="toc3">4.3.2 &nbsp;<a href="#CDA_Section_Attributes">Section Attributes</a></div>
               <div class="toc3">4.3.3 &nbsp;<a href="#CDA_Section_Participants">Section Participants</a></div>
               <div class="toc3">4.3.4 &nbsp;<a href="#CDA_Section_Relationships">Section Relationships</a></div>
               <div class="toc3">4.3.5 &nbsp;<a href="#CDA_Section_Narrative_Block">Section Narrative Block</a></div>
               <div class="toc3">4.3.6 &nbsp;<a href="#CDA_Entry_Acts">Entry Acts</a></div>
               <div class="toc3">4.3.7 &nbsp;<a href="#CDA_Entry_Participants">Entry Participants</a></div>
               <div class="toc3">4.3.8 &nbsp;<a href="#CDA_Entry_Relationships">Entry Relationships</a></div>
               <div class="toc2">4.4 &nbsp;<a href="#CDAContext">CDA Context</a></div>
               <div class="toc3">4.4.1 &nbsp;<a href="#Overview_of_CDA_Context">Overview of CDA Context</a></div>
               <div class="toc3">4.4.2 &nbsp;<a href="#Technical_Aspects_of_CDA_Context">Technical Aspects of CDA Context</a></div>
               
               <div class="toc1">5 &nbsp;<a href="#CDA_Hierarchical_Description">CDA Hierarchical Description</a></div>
               
               <div class="toc1">6 &nbsp;<a href="#CDA_Schema">CDA XML Implementation</a></div>
               
               <div class="toc1">7 &nbsp;<a href="#Appendices">Appendices</a></div>
               <div class="toc2">7.1 &nbsp;<a href="#Samples">Samples</a></div>
               <div class="toc3">7.1.1 &nbsp;<a href="#Sample_Document">Sample Document</a></div>
               <div class="toc3">7.1.2 &nbsp;<a href="#Sample_CDA_Instance">Sample CDA Instance</a></div>
               <div class="toc3">7.1.3 &nbsp;<a href="#Sample_CDA_Style_Sheet">Sample CDA Style Sheet</a></div>
               <div class="toc2">7.2 &nbsp;<a href="#Implementation_Notes">Implementation Notes</a></div>
               <div class="toc3">7.2.1 &nbsp;<a href="#Creating_CDA_Documents">Creating CDA Documents</a></div>
               <div class="toc3">7.2.2 &nbsp;<a href="#LOINC_Document_Codes">LOINC Document Codes</a></div>
               <div class="toc3">7.2.3 &nbsp;<a href="#CDA_and_Semantic_Interoperability">CDA and Semantic Interoperability</a></div>
               <div class="toc3">7.2.4 &nbsp;<a href="#Enumeration_of_Changes_Between_Release_One_and_Release_Two">Changes from CDA Release 1</a></div>
               <hr>
            </div>
            <div class="subSection">
               <!--divN/head-->
               <div class="header"><span class="icon"><img src="../../support/graphics/NormativeStandard.gif" alt="NormativeStandard"></span><span class="number"><a name="CDA_Overview"></a>1 </span><span class="title">CDA Overview</span></div>
               <div class="body">
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="What_is_the_CDA"></a>1.1 </span><span class="title">What is the CDA</span></div>
                     <div class="body">
                        <p>The HL7 Clinical Document Architecture (CDA) is a document markup standard that specifies the structure and semantics of "clinical
                           documents" for the purpose of exchange. A clinical document is a documentation of clinical observations and services, with
                           the following characteristics:				
                           <ul style="margin-left:20px;">
                              <li>Persistence &#8211; A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory
                                 requirements (<strong>NOTE:</strong> There is a distinct scope of persistence for a clinical document, independent of the persistence of any XML-encoded CDA document
                                 instance).
                                 
                                 					
                              </li>
                              <li>Stewardship &#8211; A clinical document is maintained by an organization entrusted with its care.</li>
                              <li>Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated.</li>
                              <li>Context - A clinical document establishes the default context for its contents.</li>
                              <li>Wholeness - Authentication of a clinical document applies to the whole and does not apply to portions of the document without
                                 the full context of the document.
                              </li>
                              <li>Human readability &#8211; A clinical document is human readable.</li>
                           </ul>
                        </p>
                        <p>A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content.</p>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Key_aspects_of_the_CDA"></a>1.1.1 </span><span class="title">Key aspects of the CDA</span></div>
                           <div class="body">
                              <p>Key aspects of the CDA include:
                                 
                                 					
                                 <ul style="margin-left:20px;">
                                    <li>CDA documents are encoded in Extensible Markup Language (XML). (<strong>NOTE:</strong> When alternate implementations are feasible, suitable conformance requirements will be issued so that in future the syntax
                                       may not be limited to XML.)
                                    </li>
                                    <li>CDA documents derive their machine processable meaning from the HL7 Reference Information Model (RIM) and use the HL7 Version
                                       3 Data Types.
                                    </li>
                                    <li>The CDA specification is richly expressive and flexible. Document-level, section-level and entry-level templates can be used
                                       to constrain the generic CDA specification (see <a href="#The_A_in_CDA">The "A" in "CDA"
                                          			(&sect;
                                          			1.2.2 )</a>).
                                    </li>
                                 </ul>
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Scope_of_the_CDA"></a>1.1.2 </span><span class="title">Scope of the CDA</span></div>
                           <div class="body">
                              <p>The scope of the CDA is the standardization of clinical documents for exchange. </p>
                              <p>The data format of clinical documents outside of the exchange context (e.g., the data format used to store clinical documents)
                                 is not addressed in this specification.
                              </p>
                              <p>CDA documents can be transmitted in HL7 messages designed to transfer clinical documents. While the detailed specification
                                 for such messages is outside of the scope of the CDA, this specification does impose requirements upon the packaging of CDA
                                 documents in HL7 messages (see <a href="#CDA_Document_Exchange_in_HL7_Messages">CDA Document Exchange in HL7 Messages
                                    			(&sect;
                                    			3 )</a>).
                              </p>
                              <p>The CDA does not specify the creation or management of documents, only their exchange markup. While it may be possible to
                                 directly use the CDA Schema in a document authoring environment, such use is not the primary purpose of the CDA specification.
                                 
                              </p>
                              <p>Document management is critically interdependent with the CDA specifications, but the specification of document management
                                 messages is outside the scope of the CDA. (For more on this, see <a href="#Relationship_of_the_CDA_to_HL7_Messaging_Standards">Relationship of the CDA to HL7 Messaging Standards
                                    			(&sect;
                                    			1.2.6 )</a>).
                              </p>
                              <blockquote><b>NOTE: </b>Several committees are developing structured document specifications that overlap in part with the CDA specification. The
                                 Structured Documents Technical Committee, in collaboration with Publishing and these other committees, is developing a Structured
                                 Documents Infrastructure chapter to clarify these relationships which should be available 
                                 						in upcoming editions.
                              </blockquote>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Goals_and_Design_Principles"></a>1.1.3 </span><span class="title">Goals and Design Principles</span></div>
                           <div class="body">
                              <p>The goals of the CDA are:
                                 
                                 					
                                 <ul style="margin-left:20px;">
                                    <li>Give priority to delivery of patient care.</li>
                                    <li>Allow cost effective implementation across as wide a spectrum of systems as possible.</li>
                                    <li>Support exchange of human-readable documents between users, including those with different levels of technical sophistication.</li>
                                    <li>Promote longevity of all information encoded according to this architecture.</li>
                                    <li>Enable a wide range of post-exchange processing applications.</li>
                                    <li>Be compatible with a wide range of document creation applications.</li>
                                    <li>Promote exchange that is independent of the underlying transfer or storage mechanism.</li>
                                    <li>Prepare the design reasonably quickly.</li>
                                    <li>Enable policy-makers to control their own information requirements without extension to this specification.</li>
                                 </ul>
                              </p>
                              <p>A number of design principles follow from consideration of the above goals:
                                 
                                 						
                                 <ul style="margin-left:20px;">
                                    <li>This architecture must be compatible with XML and the HL7 RIM.</li>
                                    <li>This architecture must be compatible with representations of clinical information arising from other HL7 committees.</li>
                                    <li>Technical barriers to use of the architecture should be minimized.</li>
                                    <li>The architecture specifies the representation of instances required for exchange.</li>
                                    <li>The architecture should impose minimal constraints or requirements on document structure and content required for exchange.</li>
                                    <li>The architecture must be scalable to accommodate fine-grained markup such as highly structured text and coded data.</li>
                                    <li>Document specifications based on this architecture should accommodate such constraints and requirements as supplied by appropriate
                                       professional, commercial, and regulatory agencies.
                                    </li>
                                    <li>Document specifications for document creation and processing, if intended for exchange, should map to this exchange architecture.
                                       
                                    </li>
                                    <li>CDA documents must be human readable using widely-available and commonly-deployed XML-aware browsers and print drivers and
                                       a generic CDA style sheet written in a standard style sheet language.
                                    </li>
                                    <li>Use open standards.</li>
                                 </ul>
                              </p>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="General_CDA_Concepts"></a>1.2 </span><span class="title">General CDA Concepts</span></div>
                     <div class="body">
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Major_Components_of_a_CDA_Document"></a>1.2.1 </span><span class="title">Major Components of a CDA Document</span></div>
                           <div class="body">
                              <p>This section serves as a high-level introduction to the major components of a CDA document, all of which are described again
                                 and in greater detail later on. The intent here is to familiarize the reader with the high-level concepts to facilitate an
                                 understanding of the sections that follow. 
                              </p>
                              <p>Major components of a prototypic CDA document are shown in the following skeletal example. (Note that many required components
                                 are missing to simplify the example. See <a href="#Samples">Samples
                                    			(&sect;
                                    			7.1 )</a> for a detailed conformant example).
                              </p>
                              <p>A CDA document is wrapped by the &lt;ClinicalDocument&gt; element, and contains a header (see <a href="#CDA_Header">Header
                                    			(&sect;
                                    			4.2 )</a>) and a body (see <a href="#CDA_Body">Body
                                    			(&sect;
                                    			4.3 )</a>). The header lies between the &lt;ClinicalDocument&gt; and the &lt;structuredBody&gt; elements, and identifies and classifies the document
                                 and provides information on authentication, the encounter, the patient, and the involved providers. 
                              </p>
                              <p>The body contains the clinical report, and can be either an unstructured blob, or can be comprised of structured markup. The
                                 example shows a structured body, which is wrapped by the &lt;structuredBody&gt; element, and which is divided up into recursively
                                 nestable document sections.
                              </p>
                              <p>A CDA document section is wrapped by the &lt;section&gt; element. Each section can contain a single narrative block (see <a href="#CDA_Section_Narrative_Block">Section Narrative Block
                                    			(&sect;
                                    			4.3.5 )</a>), and any number of CDA entries (see <a href="#CDA_Entry_Acts">Entry Acts
                                    			(&sect;
                                    			4.3.6 )</a>) and external references.
                              </p>
                              <p>The CDA narrative block is wrapped by the &lt;text&gt; element within the &lt;section&gt; element, and must contain the human readable
                                 content to be rendered. See also <a href="#Human_Readability_and_Rendering_CDA_Documents">Human Readability and Rendering CDA Documents
                                    			(&sect;
                                    			1.2.3 )</a> and <a href="#CDA_Conformance">CDA Conformance
                                    			(&sect;
                                    			1.3 )</a> for principles governing the representation of the narrative block, and conformance requirements on the part of originators
                                 when populating the block, and recipients when rendering it.
                              </p>
                              <p>Within a document section, the narrative block represents content to be rendered, whereas CDA entries represent structured
                                 content provided for further computer processing (e.g. decision support applications). CDA entries typically encode content
                                 present in the narrative block of the same section. The example shows two &lt;observation&gt; CDA entries, and a &lt;substanceAdministration&gt;
                                 entry containing a nested &lt;supply&gt; entry, although several other CDA entries are defined. 
                              </p>
                              <p>CDA entries can nest and they can reference external objects. CDA external references always occur within the context of a
                                 CDA entry. External references refer to content that exists outside this CDA document - such as some other image, some other
                                 procedure, or some other observation (which is wrapped by the &lt;externalObservation&gt; element). Externally referenced material
                                 is not covered by the authentication of the document referencing it.
                              </p>
                              <p>
                                 <table width="90%">
                                    <caption>Example 1. Major components of a CDA document</caption>
                                    <tr>
                                       <td class="example"><pre><pre>
&lt;ClinicalDocument&gt;
  ... CDA Header ...
  &lt;structuredBody&gt;
    &lt;section&gt;
      &lt;text&gt;...&lt;/text&gt;
      &lt;observation&gt;...&lt;/observation&gt;
      &lt;substanceAdministration&gt;
        &lt;supply&gt;...&lt;/supply&gt;
      &lt;/substanceAdministration&gt;
      &lt;observation&gt;
        &lt;externalObservation&gt;...
        &lt;/externalObservation&gt;
      &lt;/observation&gt;
    &lt;/section&gt;
    &lt;section&gt;
        &lt;section&gt;...&lt;/section&gt;
    &lt;/section&gt;
  &lt;/structuredBody&gt;
&lt;/ClinicalDocument&gt;
</pre></pre></td>
                                    </tr>
                                 </table>
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="The_A_in_CDA"></a>1.2.2 </span><span class="title">The "A" in "CDA"</span></div>
                           <div class="body">
                              <p>The notion of CDA "levels" in CDA, Release One anticipated a hierarchical set of XML DTDs or XML Schemas to achieve the goals
                                 enumerated above (see <a href="#Goals_and_Design_Principles">Goals and Design Principles
                                    			(&sect;
                                    			1.1.3 )</a>). This hierarchy formed an "architecture", hence the "A" in "CDA". 
                              </p>
                              <p>While the notion of levels in CDA, Release Two remains constant, the approach to representing the hierarchies has changed.
                                 The current specification consists of a single CDA XML Schema, and the architecture arises from the ability to apply one or
                                 more of a hierarchical set of HL7 Templates, which serve to constrain the richness and flexibility of CDA.
                              </p>
                              <blockquote><b>NOTE: </b>The CDA can be constrained by mechanisms defined in <a href="../../infrastructure/conformance/conformance.htm#">HL7 V3 Refinement and Localization</a>. HL7 technical formalisms (e.g. HL7 Template specifications, HL7 Model Interchange Format) to constrain CDA are still in
                                 development at the time of writing this standard.<br><br>
                                 
                                 						The RIM's <a href="../../infrastructure/rim/rim.htm#InfrastructureRoot-cls">InfrastructureRoot class</a> contains an attribute, templateId, which is available for use in CDA. Thus, while HL7 Templates are in flux at this time,
                                 CDA provides a mechanism to reference a template or implementation guide that has been assigned a unique identifier. Until
                                 there is a formal HL7 Template specification, there is no standardized process to test conformance against referenced templates.<br><br>
                                 
                                 						There is no requirement that CDA must be constrained. Implementations that use structured data elements to drive automated
                                 processes will typically require that they be either: (1) constrained by an appropriately refined model or other HL7 approved
                                 constraint language; or (2) comply with a detailed implementation guide that details the manner in which structured elements
                                 are to be represented and their intended interpretation to a level sufficient to ensure a degree of clinical safety that is
                                 appropriate to the use case that it is designed to address.
                              </blockquote>
                              <p>There are many kinds of HL7 Templates that might be created. Among them, two are particularly relevant for clinical documents:
                                 (1) those that constrain the document sections based on the type of document (section-level templates); (2) those that constrain
                                 the entries within document sections (entry-level templates). In fact, a comparison can be made between the prior notion of
                                 CDA levels and the current notion of CDA with these two kinds of HL7 Templates:
                              </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption><a name="Evolution">&nbsp;</a>
                                    			Table
                                    			1: Evolution of CDA "levels" from CDA, Release One to CDA, Release Two
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">CDA, Release One</th>
                                       <th colspan="1">CDA, Release Two</th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>CDA Level One</p>
                                    </td>
                                    <td colspan="1">
                                       <p>The unconstrained CDA specification.</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>CDA Level Two</p>
                                    </td>
                                    <td colspan="1">
                                       <p>The CDA specification with section-level templates applied.</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>CDA Level Three</p>
                                    </td>
                                    <td colspan="1">
                                       <p>The CDA specification with entry-level (and optionally section-level) templates applied.</p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                              <p>An illustration of one possible hierarchy of CDA plus HL7 Templates is shown here:</p>
                              <table width="90%">
                                 <caption>Example 2. Illustration of a possible CDA Document Hierarchy</caption>
                                 <tr>
                                    <td class="example"><pre><ul style="margin-left:20px;"><li>CDA Schema

    <ul><li>CDA Schema :: Progress Note section-level template applied.

        <ul><li>CDA Schema :: Progress Note section-level and Vital Signs entry-level template applied.

            <ul><li>CDA Schema :: Endocrinology Progress Note section-level and Vital Signs entry-level template applied.</li><li>CDA Schema :: Progress Note section-level and ICU Vital Signs entry-level template applied.

</li></ul></li></ul></li><li>CDA Schema :: Cardiology Progress Note section-level template applied

        <ul><li>CDA Schema :: Cardiology Progress Note section-level and Cardiac Exam entry-level template applied.

</li></ul></li><li>CDA Schema :: Endocrinology Progress Note section-level template applied.

        <ul><li>CDA Schema :: Endocrinology Progress Note section-level and Vital Signs entry-level template applied.</li></ul></li></ul></li></ul></pre></td>
                                 </tr>
                              </table>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Human_Readability_and_Rendering_CDA_Documents"></a>1.2.3 </span><span class="title">Human Readability and Rendering CDA Documents</span></div>
                           <div class="body">
                              <p>The CDA requirement for human readability guarantees that a receiver of a CDA document can algorithmically display the clinical
                                 content of the note on a standard Web browser. CDA, Release Two, with its blend of narrative and CDA entries, presents new
                                 challenges to this requirement. 
                              </p>
                              <p>Among the requirements affecting the design of CDA Release 2 are the following:</p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>There must be a deterministic way for a recipient of an arbitrary CDA document to render the attested content.</li>
                                    <li>Human readability shall not require a sender to transmit a special style sheet along with a CDA document. It must be possible
                                       to render all CDA documents with a single style sheet and general-market display tools.
                                    </li>
                                    <li>Human readability applies to the authenticated content. There may be additional information conveyed in the document that
                                       is there primarily for machine processing that is not authenticated and need not be rendered.
                                    </li>
                                    <li>When structured content is derived from narrative, there must be a mechanism to describe the process (e.g. by author, by human
                                       coder, by natural language processing algorithm, by specific software) by which machine-processable portions were derived
                                       from a block of narrative.
                                    </li>
                                    <li>When narrative is derived from structured content, there must be a mechanism to identify the process by which narrative was
                                       generated from structured data.
                                    </li>
                                 </ul>
                              </p>
                              <p>These principles and requirements have led to the current approach, where the material to be rendered is placed into the Section.text
                                 field (see <a href="#CDA_Section_Narrative_Block">Section Narrative Block
                                    			(&sect;
                                    			4.3.5 )</a>). The content model of this field is specially hand crafted to meet the above requirements, and corresponds closely to the
                                 content model of sections in CDA, Release One. Structured observations can reference narrative content in the Section.text
                                 field. Multimedia observations are encoded outside the Section.text field, and the &lt;renderMultiMedia&gt; tag within the Section.text
                                 field provides an outgoing pointer that indicates where the referenced multimedia should be rendered.
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="XML_Markup_of_CDA_Documents"></a>1.2.4 </span><span class="title">XML Markup of CDA Documents</span></div>
                           <div class="body">
                              <p>XML markup of CDA documents is prescribed in this specification. CDA instances are valid against the CDA Schema and may be
                                 subject to additional validation (see <a href="#CDA_Conformance">CDA Conformance
                                    			(&sect;
                                    			1.3 )</a>). There is no prohibition against multiple schema languages (e.g., W3C, DTD, RELAXNG), as long as conforming instances are
                                 compatible. 
                              </p>
                              <p>Design Principles of the CDA Schema include:
                                 
                                 
                                 					
                                 <ul style="margin-left:20px;">
                                    <li><strong>General Requirements: </strong>The design of the CDA Schema follows the more general requirements for CDA (see <a href="#Goals_and_Design_Principles">Goals and Design Principles
                                          			(&sect;
                                          			1.1.3 )</a>).
                                    </li>
                                    <li><strong>CDA Schema and V3 Implementation Technology Specification (ITS) : </strong>The CDA Schema will follow the general V3 XML ITS.
                                    </li>
                                    <li><strong>RIM Mapping: </strong>
                                       
                                       The CDA Schema describes the style of XML markup of CDA instances for the purpose of exchange. It cannot be understood outside
                                       the context of this defining specification. At the same time, the CDA Schema is useful on its own for implementation purposes
                                       even though it is not intended to replicate or take the place of the R-MIM and HD. The CDA Schema, then, is not, in and of
                                       itself, an adequate map between conforming instance and the HL7 RIM. Semantic interoperability of CDA instances requires use
                                       and knowledge of the CDA Schema, R-MIM and HD as well as the corresponding RIM.
                                       
                                       
                                    </li>
                                    <li><strong>Document Analysis: </strong>The CDA Schema and conformant instances should adhere to the requirements of document analysis in derivation of the content
                                       model.
                                       
                                       								
                                       
                                       									
                                       <p><strong>NOTE: </strong>Document analysis is a process that might be thought of as the document equivalent of a use case. Document analysis looks
                                          at a single instance or class of documents and analyzes their structure and content, often representing this as a tree structure
                                          "elm" notation. Document analysis also looks at the business rules for the lifecycle of that document or document class. Traditionally,
                                          document analysis determines the content model and overall structure and style of XML. <br><br>Document analysis is an iterative step in content model derivation -- the "bottom up" approach to complement the "top down"
                                          derivation from the RIM. This will ensure that schemas and instances are not only RIM-derived, but represent recognizable
                                          artifacts in a simple manner.
                                       </p>
                                    </li>
                                    <li><strong>Forward and Backward Compatibility: </strong>The CDA Schema should adhere to the requirements for forward and backward compatibility. (See <a href="#Backwards_and_Forwards_Compatibility">Backwards and Forwards Compatibility
                                          			(&sect;
                                          			1.5 )</a>)
                                    </li>
                                    <li><strong>Naming: </strong>While XML markup, by definition, is for machine processing, it should be optimized for human review, debug, and design. The
                                       CDA Schema is not "self-documenting", but meaning should be clear from tag name and documentation (e.g., mapping to RIM).
                                       The human-language sense of a tag name should not be counterintuitive.
                                    </li>
                                    <li><strong>Vocabulary:</strong> Vocabulary can be enumerated within the CDA Schema or in an external, referenced source. It is preferable to enumerate it
                                       when the vocabulary terms are both limited (not too large in number) and stable (not subject to change between ballot cycles).
                                       Where vocabulary is either too large or is subject to change, it is preferable to maintain it external to the CDA Schema and
                                       incorporate it by reference. In these cases, XML schema validation will not suffice for conformance.
                                    </li>
                                 </ul>
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Security_Confidentiality_and_Data_Integrity"></a>1.2.5 </span><span class="title">Security, Confidentiality, and Data Integrity</span></div>
                           <div class="body">
                              <p>Application systems sending and receiving CDA documents are responsible for meeting all legal requirements for document authentication,
                                 confidentiality, and retention. For communications over public media, cryptographic techniques for source/recipient authentication
                                 and secure transport of encapsulated documents may be required, and should be addressed with commercially available tools
                                 outside the scope of this standard. 
                              </p>
                              <p>The CDA does provide confidentiality status information to aid application systems in managing access to sensitive data. 
                                 Confidentiality status may apply to the entire document or to specified segments of the document.
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Relationship_of_the_CDA_to_HL7_Messaging_Standards"></a>1.2.6 </span><span class="title">Relationship of the CDA to HL7 Messaging Standards</span></div>
                           <div class="body">
                              <p>A CDA document is a defined and complete information object that can exist outside of a messaging context and/or can be a
                                 payload within an HL7 message (see <a href="#CDA_Document_Exchange_in_HL7_Messages">CDA Document Exchange in HL7 Messages
                                    			(&sect;
                                    			3 )</a>). Thus, the CDA complements HL7 messaging specifications.
                              </p>
                              <p>Clinical documents can be revised, and they can be appended to existing documents. Ideally, an updated document would declare
                                 itself as obsolete, and would contain an explicit pointer to a more recent version. This would lessen the chances of a healthcare
                                 provider basing treatment decisions on erroneous or incomplete data. 
                              </p>
                              <p>In practice, however, it is impossible to guarantee an explicit forward pointer from an outdated version to the newer version.
                                 Without a process that tracks the chain of custody of clinical documents and all of their copies, there can be no way to guarantee
                                 that a clinical document being viewed has not been subsequently revised. 
                              </p>
                              <p>To minimize the risk of viewing superseded information, there is a critical interdependence between clinical documents and
                                 document management systems. If CDA documents are viewed outside the context of a document management system, it cannot be
                                 known with certainty whether or not the viewed document has been revised. HL7 messages that carry CDA documents (such as the
                                 MDM messages in HL7 V2.x and the <b><a class="elink" href="../../domains/mr/hmrcmr.htm#">HL7 V3 Medical Records messages</a></b>) convey critical contextual information that ensures accurate viewing of clinical data.
                              </p>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Conformance"></a>1.3 </span><span class="title">CDA Conformance</span></div>
                     <div class="body">
                        <blockquote><b>NOTE: </b>
                           
                           					See <a href="../../infrastructure/conformance/conformance.htm#">HL7 V3 Refinement and Localization</a> for a complete discussion of V3 conformance. 
                        </blockquote>
                        <p>A conformant CDA document is one that at a minimum validates against the CDA Schema, and that restricts its use of coded vocabulary
                           to values allowable within the specified vocabulary domains. However a computer cannot validate every aspect of conformance.
                           The focus of this section is to highlight these aspects of CDA that cannot be machine validated - particularly those aspects
                           related to the CDA human readability requirements.
                        </p>
                        <p>A document originator is an application role that creates a CDA document. CDA documents can be created via transformation
                           from some other format, as a direct output of an authoring application, etc. The document originator often is responsible
                           for communicating with a persistent storage location, often using HL7 V2 MDM or <b><a class="elink" href="../../domains/mr/hmrcmr.htm#">HL7 V3 Medical Records messages</a></b>.  The document originator is responsible for ensuring that generated CDA documents are fully conformant to this specification.
                        </p>
                        <p>A document recipient is an application role that receives status updates and documents from a document originator or document
                           management system. The document recipient is responsible for ensuring that received CDA documents are rendered in accordance
                           to this specification.
                        </p>
                        <p>Because CDA is an exchange standard and may not represent the original form of a document, there are no persistent storage
                           requirements for CDA documents defined in this standard. However, as noted above (see <a href="#Relationship_of_the_CDA_to_HL7_Messaging_Standards">Relationship of the CDA to HL7 Messaging Standards
                              			(&sect;
                              			1.2.6 )</a>), document management is critically interdependent with the CDA specification. The custodian identified in the CDA header
                           (see <a href="#custodian">custodian
                              			(&sect;
                              			4.2.2.3 )</a>) is the participant charged with maintaining the original document, which may be in some form other than CDA.
                        </p>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Recipient_Responsibilities"></a>1.3.1 </span><span class="title">Recipient Responsibilities</span></div>
                           <div class="body">
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li><strong>Assume default values where they are defined in this specification, and where the instance does not contain a value</strong> : Where CDA defines default values, the recipient must assume these values in the event that no value is contained in a CDA
                                       instance. (<strong>NOTE:</strong> Default values are indicated in the body of this document by flagging them as "[<strong>default</strong>]".)
                                    </li>
                                    <li><strong>Parse and interpret the complete CDA header</strong> : A recipient of a CDA document must be able to parse and interpret the complete CDA header. Because applications may choose
                                       to display demographic and other CDA header data drawn from a central master directory, the rendering of the CDA document
                                       header is at the discretion of the recipient. In addition, rendering of the CDA document header can be dependent on local
                                       business practice and context of use (e.g. electronic health record, de-identified scenario). Where a document originator
                                       wants to suggest a rendering, they can include one or more XML style sheets with an exchanged CDA document. Use of these style
                                       sheets is at the discretion of the recipient.
                                    </li>
                                    <li><strong>Parse and interpret the CDA body sufficiently to be able to render it</strong> : A recipient of a CDA document must be able to parse and interpret the body of a CDA document sufficiently to be able to
                                       render it, using the following rendering rules:
                                       
                                       								
                                       <ul>
                                          <li>If the CDA Body is non-XML, it will need to be rendered with a software tool that recognizes its particular MIME media type.</li>
                                          <li>If the CDA Body is structured, the label of a section, as conveyed in the Section.title component, must be rendered. The absence
                                             of the Section.title component signifies an unlabeled section.
                                             
                                             
                                          </li>
                                          <li>If the CDA Body is structured, the contents of the Section.text field must rendered per the rules defined in <a href="#CDA_Section_Narrative_Block">Section Narrative Block
                                                			(&sect;
                                                			4.3.5 )</a>.
                                          </li>
                                       </ul>
                                    </li>
                                    <li>A recipient of a CDA document is not required to parse and interpret the complete set of CDA entries contained within the
                                       CDA body. Within a local implementation, trading partners may ascribe additional recipient responsibilities to parse and interpret
                                       various entries.
                                    </li>
                                    <li>A recipient of a CDA document is not required to validate a CDA document against referenced templates. Within a local implementation,
                                       trading partners may ascribe additional recipient responsibilities for template validation.
                                    </li>
                                 </ul>
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Originator_Responsibilities"></a>1.3.2 </span><span class="title">Originator Responsibilities</span></div>
                           <div class="body">
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li><strong>Properly construct CDA Narrative Blocks</strong> : An originator of a CDA document must ensure that the attested portion of the document body is structured such that a recipient,
                                       adhering to the recipient responsibilities above, will correctly render the document. This includes: 
                                       
                                       							
                                       <ul>
                                          <li>If the CDA Body is structured, the label of a section must be conveyed in the Section.title component. The absence of the
                                             Section.title component signifies an unlabeled section.
                                          </li>
                                          <li>If the CDA Body is structured, the attested narrative contents of a section must be placed in the Section.text field, regardless
                                             of whether information is also conveyed in CDA entries. Attested multimedia referenced in the narrative must be added as ObservationMedia
                                             and/or RegionOfInterest CDA entries.
                                          </li>
                                          <li>If the CDA Body is structured, the contents of the Section.text field must be created per the rules defined in <a href="#CDA_Section_Narrative_Block">Section Narrative Block
                                                			(&sect;
                                                			4.3.5 )</a></li>
                                       </ul>
                                    </li>
                                    <li>An originator of a CDA document is not required to fully encode all narrative into CDA entries within the CDA body. Within
                                       a local implementation, trading partners may ascribe additional originator responsibilities to create various entries. 
                                       
                                       
                                    </li>
                                 </ul>
                              </p>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Extensibility"></a>1.4 </span><span class="title">CDA Extensibility</span></div>
                     <div class="body">
                        <blockquote><b>NOTE: </b>See <a href="../../infrastructure/itsxml/messaging-its-xml.htm#informalExtensions">XML ITS - Informal Extensions</a> for a complete discussion of V3 XML Extensibility rules. 
                        </blockquote>
                        <p>Locally-defined markup may be used when local semantics have no corresponding representation in the CDA specification. CDA
                           seeks to standardize the highest level of shared meaning while providing a clean and standard mechanism for tagging meaning
                           that is not shared. In order to support local extensibility requirements, it is permitted to include additional XML elements
                           and attributes that are not included in the CDA schema.  These extensions should not change the meaning of any of the standard
                           data items, and receivers must be able to safely ignore these elements. Document recipients must be able to faithfully render
                           the CDA document while ignoring extensions.
                           
                           
                        </p>
                        <p>Extensions may be included in the instance in a namespace other than the HL7v3 namespace, but must not be included within
                           an element of type ED (e.g., &lt;text&gt; within &lt;procedure&gt;) since the contents of an ED datatype within the conformant document
                           may be in a different namespace. Since all conformant content (outside of elements of type ED) is in the HL7 namespace, the
                           sender can put any extension content into a foreign namespace (any namespace other than the HL7 namespace).  Receiving systems
                           must not report an error if such extensions are present.
                        </p>
                        <p>When these extension mechanisms mark up content of general relevance, HL7 encourages users to get their requirements formalized
                           in a subsequent version of the standard so as to maximize the use of shared semantics.
                           
                           
                        </p>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Backwards_and_Forwards_Compatibility"></a>1.5 </span><span class="title">Backwards and Forwards Compatibility</span></div>
                     <div class="body">
                        <blockquote><b>NOTE: </b>A detailed list of all changes between CDA, Release One and CDA, Release Two can be found in the appendix (see <a href="#Enumeration_of_Changes_Between_Release_One_and_Release_Two">Changes from CDA Release 1
                              			(&sect;
                              			7.2.4 )</a>). 
                        </blockquote>
                        <p>The basic model of CDA, Release Two is essentially unchanged. A CDA document has a header and a body. The body contains nested
                           sections. These sections can be coded using standard vocabularies, and can contain CDA entries. The main evolutionary steps
                           in CDA, Release Two are that both header and body are fully RIM-derived, and there is a much richer assortment of entries
                           to use within CDA sections. CDA, Release Two enables clinical content to be formally expressed to the extent that it is modeled
                           in the RIM.
                        </p>
                        <p>This section describes the types of changes that can be introduced to a new release of CDA and CDA principles of forward and
                           backward compatibility. In general, changes can include the addition of new components; a renaming of components (including
                           XML element and attribute names in the CDA Schema); a deprecation of components defined in a prior release; a change in cardinality
                           of a component (either to tighten or to loosen); or a change in a vocabulary domain of a component (to add or change values,
                           to change between CWE and CNE). The following set of guiding principles defines how CDA can continue to evolve, while protecting
                           the investment implementers have made through their adoption of earlier releases.
                           
                           				
                           <ul style="margin-left:20px;">
                              <li><strong>Documentation</strong> : A new release of CDA will enumerate all substantive changes from the previous release.
                                 
                                 
                              </li>
                              <li><strong>Attested content</strong>: Attested, human readable content must be completely loss-less across CDA releases. Backwards and forwards compatibility
                                 on the attested content will be supported such that it will be possible for an automated transformation script to translate
                                 the human readable content in both directions. 
                              </li>
                              <li><strong>New components</strong> : A new release of CDA can introduce new components. To preserve roundtrip translation capability, a translation from the
                                 new release to a prior release must represent the new components as extensions (e.g. local markup or local namespace).
                              </li>
                              <li><strong>Renaming </strong> : A new release of CDA can rename components (including XML element and attribute names). Where this occurs, a mapping table
                                 will list all changes. Renaming will adhere to the naming convention articulated above (see <a href="#XML_Markup_of_CDA_Documents">XML Markup of CDA Documents
                                    			(&sect;
                                    			1.2.4 )</a>).
                              </li>
                              <li><strong>Deprecated components</strong> : A new release of CDA can deprecate components defined in a prior release. Deprecated components will be removed from the
                                 subsequent release of the standard, and therefore their use is not recommended. 
                              </li>
                              <li><strong>Cardinality</strong> : A new release of CDA can change the cardinality of a component. Where an optional component becomes required, a translation
                                 between releases requires a dummy value or a null value.
                              </li>
                              <li><strong>Changes to vocabulary domain</strong> : A new release of CDA can change the vocabulary domain of a component. Where this occurs, a mapping table will list changes.
                                 
                              </li>
                              <li><strong>Change within CNE</strong> : Where a value in a CNE domain in a prior release is no longer present or has been renamed, a mapping table will indicate
                                 what the current value should be.
                              </li>
                              <li><strong>Change within CWE</strong> :  When a CWE domain is expanded, users should begin using the new codes in addition to any equivalent local codes they may
                                 already be using. 
                              </li>
                              <li><strong>Change from CWE to CNE</strong> : To preserve roundtrip translation capability, a translation between releases must represent unrecognized components as
                                 extensions (e.g. local markup or local namespace). Ideally these situations will surface during a ballot cycle, allowing the
                                 CNE domain to be sufficiently inclusive. 
                              </li>
                           </ul>
                        </p>
                        <p>These guiding principles have lead to the current approach, defined in this Release Two of the CDA standard. The goal is to
                           ensure that the documents created using Release One can be transformed into minimally compliant Release Two instances and
                           that Release Two documents received can be down-translated to Release One instances using automated means (transformations)
                           with no loss of attested, human-readable content and known limitation on loss of universal processing semantics.
                        </p>
                     </div>
                  </div>
               </div>
            </div>
            <div class="subSection">
               <!--divN/head-->
               <div class="header"><span class="icon"><img src="../../support/graphics/Reference.gif" alt="Reference"></span><span class="number"><a name="Introduction_to_CDA_Technical_Artifacts"></a>2 </span><span class="title">Introduction to CDA Technical Artifacts</span></div>
               <div class="body">
                  <p>A complete understanding of CDA requires an understanding of the normative artifacts used to define the specification. <strong>The CDA Hierarchical Description is the definitive source for CDA conformance rules</strong>, and serves as the source from which the CDA Schema is derived. While a CDA instance must validate against the CDA Schema,
                     it must also adhere to the conformance rules stated in the CDA Hierarchical Description. The CDA Hierarchical Description
                     is derived from the CDA R-MIM, which in turn is derived from the HL7 Reference Information Model (RIM). The HL7 RIM is the
                     definitive source for class and attribute definitions. 
                  </p>
                  <p>The following sections summarize the artifacts used by CDA, and how they can be used by those seeking to implement or understand
                     the CDA specification.
                  </p>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="HL7_Reference_Information_Model"></a>2.1 </span><span class="title">HL7 Reference Information Model</span></div>
                     <div class="body">
                        <p>The definitive description of the HL7 Reference Information Model can be found <a href="../../infrastructure/rim/rim.htm#">here</a>.
                        </p>
                        <p>The HL7 RIM is the definitive reference source for class and attribute definitions. The CDA specification does not exhaustively
                           replicate RIM definitions, but instead refers the reader to the RIM for complete definitions. While CDA may further constrain
                           RIM definitions, at no time will CDA definitions conflict with those in the RIM.
                        </p>
                        <p>CDA, Release Two is derived from HL7 RIM, Version 2.07. </p>
                        <p>Where a reader needs to see the complete definition of a RIM attribute or class, they should refer to the HL7 RIM. 
                           
                           
                        </p>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="HL7_V3_Data_Types"></a>2.2 </span><span class="title">HL7 V3 Data Types</span></div>
                     <div class="body">
                        <p>HL7 defines both an <a href="../../infrastructure/datatypes/datatypes.htm#">abstract data type specification</a>, which is the definitive reference, and an <a href="../../infrastructure/itsxml/datatypes-its-xml.htm#">XML-specific data type representation</a>. 
                           
                           
                        </p>
                        <p>Data types define the structural format of the data carried within a RIM attribute and influence the set of allowable values
                           an attribute may assume. Some data types have very little intrinsic semantic content. However HL7 also defines more extensive
                           data types such as the one for an entity's name. Every attribute in the RIM is associated with one and only one data type.
                        </p>
                        <p>CDA, Release Two uses the HL7 V3 Data Types, Release One abstract and XML-specific specification. 
                           
                           
                        </p>
                        <p>A reader will often find that the XML-specific description of a data type is sufficient for implementation, but at times will
                           want to refer to the abstract data type specification for a more comprehensive discussion.
                        </p>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="HL7_Vocabulary_Domains"></a>2.3 </span><span class="title">HL7 Vocabulary Domains</span></div>
                     <div class="body">
                        <p>The definitive description of HL7 V3 Vocabulary Domains can be found <a href="../../infrastructure/vocabulary/vocabulary.htm#">here</a>.
                        </p>
                        <p>Vocabulary domains represent value sets for coded CDA components. These domains can include HL7-defined concepts or can be
                           drawn from HL7-recognized coding systems such as LOINC or SNOMED. The HL7 Vocabulary chapter is the definitive reference source
                           for the definitions of HL7-defined concepts. While CDA may further constrain these definitions, at no time will CDA definitions
                           conflict with those in the Vocabulary chapter.
                        </p>
                        <p>Vocabulary domains have a coding strength that can be "Coded, No Extensions" (CNE), in which case the only allowable values
                           for the CDA component are those in stated value set; or "Coded, With Extensions" (CWE), in which case values outside the stated
                           value set can be used if necessary. Every vocabulary domain has a unique HL7-assigned identifier, and every concept within
                           a vocabulary domain has a unique code. 
                        </p>
                        <p>Where a coded CDA component is associated with a CNE value set, the allowable values are fixed by the standard, and are enumerated
                           as shown in the following example:
                        </p>
                        <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                           <caption>
                              			Table
                              			2: Value set for relatedDocument.typeCode (CNE)
                           </caption>
                           <thead>
                              <tr>
                                 <th colspan="1">Code </th>
                                 <th colspan="1">Definition</th>
                              </tr>
                           </thead>
                           <tr>
                              <td colspan="1">
                                 <p>APND (append)</p>
                              </td>
                              <td colspan="1">
                                 <p>The current document is an addendum to the ParentDocument.</p>
                              </td>
                           </tr>
                           <tr>
                              <td colspan="1">
                                 <p>RPLC (replace)</p>
                              </td>
                              <td colspan="1">
                                 <p>The current document is a replacement of the ParentDocument.</p>
                              </td>
                           </tr>
                           <tr>
                              <td colspan="1">
                                 <p>XFRM (transform)</p>
                              </td>
                              <td colspan="1">
                                 <p>The current document is a transformation of the ParentDocument.</p>
                              </td>
                           </tr>
                        </table>
                        <p></p>
                        <p>A number of vocabulary domains and coding systems already in existence (e.g., LOINC, SNOMED) may be used to encode concepts
                           in CDA documents (e.g., Section.code, Observation.code). These domains are referenced as external domains according to HL7
                           V3 processes. Where a coded CDA component is associated with a CWE vocabulary domain, a preferred value set may be specified
                           by the standard (such as for ClinicalDocument.code or for ClinicalDocument.confidentialityCode). Where the standard does not
                           enumerate any values, the implementor is free to choose from any external source, such as LOINC or SNOMED or some other realm-specific
                           vocabulary.
                        </p>
                        <p>Where a reader needs to see the complete definition of an HL7-defined value, they should refer to the HL7 Vocabulary chapter.
                           
                        </p>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="HL7_CDA_RMIM"></a>2.4 </span><span class="title">HL7 CDA R-MIM</span></div>
                     <div class="body">
                        <p>The definitive description of the HL7 V3 model refinement process, R-MIM development and interpretation can be found <a href="../../help/v3guide/v3guide.htm#v3dmim">here</a>.
                        </p>
                        <p>The CDA R-MIM is described below (see <a href="#CDA_RMIM">CDA R-MIM
                              			(&sect;
                              			4 )</a>).
                        </p>
                        <p>
                           
                           HL7 specifications derived from the HL7 RIM use a process known as "cloning" to refine domain specific models from the base
                           HL7 RIM. When a refined model makes use of a specialization of an HL7 RIM class, the new class in the refined model is known
                           as a clone of the HL7 RIM class. These specializations may further constrain the base class, for example, by specifying more
                           restrictive attribute cardinality or by further constraints on the allowed vocabulary values. Multiple clones of a particular
                           HL7 RIM class may appear in a refined model, each representing a different specialization.
                        </p>
                        <p>The CDA R-MIM is a graphical representation of the CDA specification. It is presented using diagramming conventions and notations
                           that were developed by HL7 to represent the specific semantic constructs contained in the critical, "back-bone" classes of
                           the RIM. Although it could be represented in UML notation, as the RIM is, the HL7 notation provides more details about the
                           specific constraints and class clones being represented. The HL7 diagramming convention abbreviates some relationship conventions,
                           enabling diagrams to be smaller and more concise and to convey more information visually. 
                        </p>
                        <p>The CDA R-MIM is a graphical aid to understanding the specification. Because the CDA Hierarchical Description, and subsequently
                           the CDA Schema, are derived from the R-MIM, the R-MIM serves as a good basis for describing the standard. The narrative description
                           of the specific clones used by CDA is organized to correspond with the R-MIM. 
                        </p>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="HL7_CDA_Hierarchical_Description"></a>2.5 </span><span class="title">HL7 CDA Hierarchical Description</span></div>
                     <div class="body">
                        <p>The definitive description of developing and interpreting HL7 Hierarchical Descriptions can be found <a href="../../help/v3guide/v3guide.htm#v3ghmd">here</a>.
                        </p>
                        <p>The CDA HD is described below (see <a href="#CDA_Hierarchical_Description">CDA Hierarchical Description
                              			(&sect;
                              			5 )</a>).
                        </p>
                        <p>A Hierarchical Description is a tabular representation of the sequence of elements (i.e., classes, attributes and associations)
                           represented in an R-MIM and that define the structure of the instance without reference to XML or any other implementation
                           technology. 
                        </p>
                        <p>The CDA HD is the definitive source for CDA conformance rules, and serves as the source from which the CDA Schema is derived.
                           While a CDA instance must validate against the CDA Schema, it must also adhere to the conformance rules stated in the CDA
                           Hierarchical Description. For CDA, Release Two, the CDA HD is uniquely identified by the string "POCD_HD000040". As described
                           below (see <a href="#Clinical_Document">Clinical Document
                              			(&sect;
                              			4.1 )</a>), this value must be included in a CDA instance to serve as an unambiguous reference to the CDA, Release Two specification.
                           
                           
                           
                        </p>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="HL7_CDA_Schema"></a>2.6 </span><span class="title">HL7 CDA XML Implementation</span></div>
                     <div class="body">
                        <p>The CDA Schema is derived through the use of the HL7 XML Implementation Technology Specification (ITS). The definitive description
                           of HL7 XML ITS and the process used to go from Hierarchical Description to Schema can be found <a href="../../infrastructure/itsxml/messaging-its-xml.htm#">here</a>.
                           
                           
                        </p>
                        <p>The CDA Schema is described below (see <a href="#CDA_Schema">CDA XML Implementation
                              			(&sect;
                              			6 )</a>).
                        </p>
                        <p>CDA, Release Two is based on the HL7 V3 XML Implementable Technology Specification for V3 Structures, Release One.</p>
                        <p>Specific enhancements to the CDA Schema, above and beyond those defined in the HL7 V3 XML ITS, are described below in <a href="#CDA_Schema">CDA XML Implementation
                              			(&sect;
                              			6 )</a>.
                        </p>
                        <p>Looking at the CDA R-MIM, a reader familiar with the RIM, the HL7 Development Framework and its rules for XML implementations,
                           can identify the corresponding XML elements and attributes. Due to algorithmic generation of some of the element names, the
                           correspondence may be unclear, and the reader should refer to the HL7 V3 XML ITS for more details. 
                        </p>
                     </div>
                  </div>
               </div>
            </div>
            <div class="subSection">
               <!--divN/head-->
               <div class="header"><span class="icon"><img src="../../support/graphics/NormativeStandard.gif" alt="NormativeStandard"></span><span class="number"><a name="CDA_Document_Exchange_in_HL7_Messages"></a>3 </span><span class="title">CDA Document Exchange in HL7 Messages</span></div>
               <div class="body">
                  <blockquote><b>NOTE: </b>The exact method by which a CDA instance is packaged and exchanged is outside the scope of this standard. While the MIME packaging
                     method described here is not normative, it does illustrate one mechanism that meets the document exchange requirements described
                     below.
                     
                     
                  </blockquote>
                  <p>Any CDA exchange strategy must accommodate the following requirements:
                     
                     					
                     <ul style="margin-left:20px;">
                        <li>All components of a CDA document that are integral to its state of wholeness (such as attested multimedia) are able to be
                           included in a single exchange package.
                        </li>
                        <li>Content needing to be rendered if exchanging across a firewall where the links won't be traversable, must be able to be included
                           in a single exchange package.
                        </li>
                        <li>Additional files associated with a CDA document to provide the recipient with the sender's rendering suggestions (such as
                           one or more style sheets) are able to be included in a single exchange package.
                        </li>
                        <li>There is no need to change any of the references (e.g., a reference to attested multimedia in a separate file) within the
                           base CDA document when creating the exchange package.
                        </li>
                        <li>There is no need to change any of the references (e.g., a reference to attested multimedia in a separate file) within the
                           base CDA document when extracting the contents of an exchange package.
                        </li>
                        <li>There is no need to change any values of attributes of type XML ID when creating the exchange package.</li>
                        <li>There are no restrictions on the directory structure used by receivers. Receivers can place the components of the CDA document
                           into directories of their choosing.
                        </li>
                        <li>Critical metadata about the CDA instance needed for document management (e.g. document state, document archival status) must
                           be included in the exchange package. (For a complete discussion of clinical document metadata, document management, and HL7
                           V3 document states and state transitions, refer to the <b><a class="elink" href="../../domains/mr/hmrcmr.htm#">HL7 V3 Medical Records specification</a></b>).
                           
                           
                           
                           
                        </li>
                     </ul>
                  </p>
                  <p>From the perspective of a V2.x or V3 message, a CDA document can be thought of as a multimedia object that can be exchanged
                     as a Multipurpose Internet Mail Extensions (MIME, RFC 2046) package, encoded as an encapsulated data type (ED). 
                     
                     
                     
                     
                  </p>
                  <p>The current MIME recommendation is to follow the approach described in the Internet standard RFC 2557 <a href="http://www.ietf.org/rfc/rfc2557.txt" target="_blank">"MIME Encapsulation of Aggregate Documents, such as HTML (MHTML)"</a>, which is the approach for the MIME encapsulations of aggregate documents used by ebXML and DICOM. 
                     
                     
                     
                     
                     
                     
                     
                  </p>
                  <p>In V2.x, CDA documents are to be exchanged in the OBX segment, in any message that can exchange documents (such as MDM). Within
                     the OBX segment, the MIME package is placed in OBX.5 (Field 00573 Observation value), encoded as a V2.x encapsulated data
                     type. The value of OBX.2 (Field 00570 Value Type) should be set to "ED". The value of OBX.3 should be the same as ClinicalDocument.code.
                  </p>
                  <p>Many fields in the message will overlap in meaning with fields in the CDA document. The following table shows the correspondence
                     between the HL7 V2 MDM message's TXA segment and components of CDA.
                  </p>
                  <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                     <caption>
                        			Table
                        			3: HL7 V2 TXA Segment :: CDA Mapping
                     </caption>
                     <thead>
                        <tr>
                           <th colspan="1">TXA Field </th>
                           <th colspan="1">CDA Component </th>
                        </tr>
                     </thead>
                     <tr>
                        <td colspan="1">
                           <p>TXA-2 Document type</p>
                        </td>
                        <td colspan="1">
                           <p>ClinicalDocument.code</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-4 Activity date/time</p>
                        </td>
                        <td colspan="1">
                           <p>ServiceEvent.effectiveTime</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-5 Primary activity provider code/name</p>
                        </td>
                        <td colspan="1">
                           <p>ServiceEvent performer</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-6 Origination date/time</p>
                        </td>
                        <td colspan="1">
                           <p>ClinicalDocument.effectiveTime</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-7 Transcription date/time</p>
                        </td>
                        <td colspan="1">
                           <p>dataEnterer.time</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-9 Originator code/name</p>
                        </td>
                        <td colspan="1">
                           <p>author</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-11 Transcriptionist code/name</p>
                        </td>
                        <td colspan="1">
                           <p>dataEnterer</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-12 Unique document number</p>
                        </td>
                        <td colspan="1">
                           <p>ClinicalDocument.id</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-13 Parent document number</p>
                        </td>
                        <td colspan="1">
                           <p>ParentDocument.id</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-14 Placer order number</p>
                        </td>
                        <td colspan="1">
                           <p>Order.id</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-18 Document confidentiality status</p>
                        </td>
                        <td colspan="1">
                           <p>ClinicalDocument.confidentialityCode</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-22 Authentication person, time stamp</p>
                        </td>
                        <td colspan="1">
                           <p>authenticator, legalAuthenticator</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>TXA-23 Distributed copies</p>
                        </td>
                        <td colspan="1">
                           <p>informationRecipient</p>
                        </td>
                     </tr>
                  </table>
                  <p></p>
                  <p>The following example shows a non-normative, valid use of RFC 2557 in a V2 message. Several other valid representations are
                     possible.
                  </p>
                  <table width="90%">
                     <caption>Example 3. Example of a CDA document in an MDM message</caption>
                     <tr>
                        <td class="example"><pre><pre>
MSH|...
EVN|...
PID|...
PV1|...
TXA|...
OBX|1|ED|11492-6^History and Physical^LN||
   ^multipart^related^A^
   MIME-Version: 1.0
   Content-Type: multipart/related; boundary="HL7-CDA-boundary";
   type="text/xml"; start="10.12.45567.43"
   Content-Transfer-Encoding: BASE64

   --HL7-CDA-boundary
   Content-Type: text/xml; charset="US-ASCII"
   Content-ID: &amp;lt;10.12.45567.43&gt;

   ... Base 64 of base CDA document, which contains 
      ...
      &lt;observationMedia classCode="OBS" moodCode="EVN"&gt;
         &lt;id root="10.23.4567.345"/&gt; 
         &lt;value mediaType="image/jpeg"&gt;
            &lt;reference value="left_hand_image.jpeg"/&gt;
         &lt;/value&gt;
      &lt;/observationMedia&gt;
      ...

   --HL7-CDA-boundary
   Content-ID: &amp;lt;10.23.4567.345&gt;
   Content-Location: canned_left_hand_image.jpeg
   Content-Type: image/JPEG

   ... Base64 image ...

   --HL7-CDA-boundary--

   ...
   
</pre></pre></td>
                     </tr>
                  </table>
                  <p>In V3, CDA documents can be exchanged in any message that can exchange documents (such as the <b><a class="elink" href="../../domains/mr/hmrcmr.htm#">HL7 V3 Medical Records messages</a></b>). The Act.text RIM attribute contains the MIME package, encoded as an encapsulated data type. 
                  </p>
                  <p>As is the case with V2, many fields in the V3 message will overlap in meaning with fields in the CDA document. Since CDA and
                     V3 Medical Records messages derive from a common model, the correspondence is clear, as shown in the following table. 
                  </p>
                  <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                     <caption>
                        			Table
                        			4: HL7 V3 Medical Records :: CDA Mapping
                     </caption>
                     <thead>
                        <tr>
                           <th colspan="1">HL7 V3 Medical Records Component</th>
                           <th colspan="1">CDA Component </th>
                           <th colspan="1">Comments</th>
                        </tr>
                     </thead>
                     <tr>
                        <td colspan="1">
                           <p>ClinicalDocument</p>
                        </td>
                        <td colspan="1">
                           <p>ClinicalDocument</p>
                        </td>
                        <td colspan="1">
                           <p>Medical Records includes attributes not present
                              
                              in CDA (text, statusCode, availabilityTime, reasonCode, completioncode,
                              
                              storageCode, copyTime); CDA includes attributes not present in Medical
                              
                              Records (title).
                           </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>authenticator</p>
                        </td>
                        <td colspan="1">
                           <p>authenticator</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>legalAuthenticator</p>
                        </td>
                        <td colspan="1">
                           <p>legalAuthenticator</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>dataEnterer</p>
                        </td>
                        <td colspan="1">
                           <p>dataEnterer</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>EncounterEvent / encounterPerformer</p>
                        </td>
                        <td colspan="1">
                           <p>encompassingEncounter / encounterParticipant; serviceEvent / performer</p>
                        </td>
                        <td colspan="1">
                           <p>The Medical Records encounterPerformer is split into two CDA participants.</p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>responsibleParty</p>
                        </td>
                        <td colspan="1">
                           <p>responsibleParty</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>custodian</p>
                        </td>
                        <td colspan="1">
                           <p>custodian</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>participant</p>
                        </td>
                        <td colspan="1">
                           <p>participant</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>informationRecipient</p>
                        </td>
                        <td colspan="1">
                           <p>informationRecipient</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>recordTarget</p>
                        </td>
                        <td colspan="1">
                           <p>recordTarget</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>author</p>
                        </td>
                        <td colspan="1">
                           <p>author</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>subject</p>
                        </td>
                        <td colspan="1">
                           <p>subject</p>
                        </td>
                        <td colspan="1">
                           <p>The Medical Records subject is a directory
                              
                              of all subjects listed in the document. 
                           </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>relatedDocument / ParentDocument</p>
                        </td>
                        <td colspan="1">
                           <p>relatedDocument / parentDocument</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>documentationOf / Event</p>
                        </td>
                        <td colspan="1">
                           <p>documentationOf / serviceEvent</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>inFulfillmentOf / Order</p>
                        </td>
                        <td colspan="1">
                           <p>inFulfillmentOf / order</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                     <tr>
                        <td colspan="1">
                           <p>componentOf / EncounterEvent</p>
                        </td>
                        <td colspan="1">
                           <p>componentOf / encompassingEncounter</p>
                        </td>
                        <td colspan="1">
                           <p>&nbsp; </p>
                        </td>
                     </tr>
                  </table>
                  <p></p>
                  <p>The following example shows a non-normative, valid use of RFC 2557 in a V3 message. Several other valid representations are
                     possible.
                  </p>
                  <table width="90%">
                     <caption>Example 4. Example of a CDA document in a Version 3 message</caption>
                     <tr>
                        <td class="example"><pre><pre>
&lt;someMessage&gt;
  &lt;Act.Code code="11488-4" 
    codeSystem="2.16.840.1.113883.6.1" 
    displayName="Consultation note"/&gt;
  &lt;Act.text type="multipart/related"&gt;
MIME-Version: 1.0
Content-Type: multipart/related; boundary="HL7-CDA-boundary";
type="text/xml"; start="10.12.45567.43"
Content-Transfer-Encoding: BASE64

--HL7-CDA-boundary
Content-Type: text/xml; charset="US-ASCII"
Content-ID: &amp;lt;10.12.45567.43&gt;

... Base 64 of base CDA document, which contains 
  ...
  &lt;observationMedia classCode="OBS" moodcode="EVN"&gt;
    &lt;id root="10.23.4567.345"/&gt; 
    &lt;value mediaType="image/jpeg"&gt;
      &lt;reference value="left_hand_image.jpeg"/&gt;
    &lt;/value&gt;
  &lt;/observationMedia&gt;
  ...

--HL7-CDA-boundary
Content-ID: &amp;lt;10.23.4567.345&gt;
Content-Location: canned_left_hand_image.jpeg
Content-Type: image/JPEG

... Base64 image ...

--HL7-CDA-boundary--

      &lt;/Act.text&gt;
    &lt;/someMessage&gt;
</pre></pre></td>
                     </tr>
                  </table>
               </div>
            </div>
            <div class="subSection">
               <!--divN/head-->
               <div class="header"><span class="icon"><img src="../../support/graphics/NormativeStandard.gif" alt="NormativeStandard"></span><span class="number"><a name="CDA_RMIM"></a>4 </span><span class="title">CDA R-MIM</span></div>
               <div class="body">
                  <p>NOTE: The definitive description of HL7 V3 model refinement, R-MIM development and interpretation can be found <a href="../../help/v3guide/v3guide.htm#v3dmim">here</a>.
                  </p>
                  <p>The CDA R-MIM POCD_RM000040 can be found here: <a href="graphics/L-POCD_RM000040.gif" target="_blank" border="0">Link to wide graphic (opens in a new window)</a></p>
                  <p>A CDA document is comprised of a header and a body. The header identifies and classifies the document; provides information
                     on authentication, the encounter, the patient, and the provider; and sets the context for the document as a whole. The body
                     contains the clinical report, and is conceptually divided up into nested sections, each containing a narrative block to be
                     rendered along with structured entries and external references. 
                  </p>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Clinical_Document"></a>4.1 </span><span class="title">Clinical Document</span></div>
                     <div class="body">
                        <p>The ClinicalDocument class is the entry point into the CDA R-MIM, and corresponds to the &lt;ClinicalDocument&gt; XML element that
                           is the root element of a CDA document.
                        </p>
                        <p>A CDA document is logically broken up into a CDA Header and a CDA Body. The CDA Header is comprised of ClinicalDocument attributes,
                           participants, and act relationships. The CDA Body is the target of the ClinicalDocument component act relationship.
                        </p>
                        <p>The ClinicalDocument class inherits various attributes from the <a href="../../infrastructure/rim/rim.htm#InfrastructureRoot-cls">InfrastructureRoot class</a> of the RIM, including ClinicalDocument.templateId and ClinicalDocument.typeId. When ClinicalDocument.templateId is valued
                           in an instance, it signals the imposition of a set of template-defined constraints. In addition, the templateId attribute
                           is available in all other CDA classes, thus enabling the imposition of a set of template-defined constraints at any level
                           of granularity. The value of this attribute provides a unique identifier for the template(s) in question. 
                        </p>
                        <p>ClinicalDocument.typeId is a technology-neutral explicit reference to this CDA, Release Two specification, and must be valued
                           as follows: ClinicalDocument.typeId.root = "2.16.840.1.113883.1.3" (which is the OID for HL7 Registered models); ClinicalDocument.typeId.extension
                           = "POCD_HD000040" (which is the unique identifier for the CDA, Release Two Hierarchical Description).
                        </p>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Header"></a>4.2 </span><span class="title">Header</span></div>
                     <div class="body">
                        <p>The purpose of the CDA header is to enable clinical document exchange across and within institutions; facilitate clinical
                           document management; and facilitate compilation of an individual patient's clinical documents into a lifetime electronic patient
                           record. 
                        </p>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Header_Attributes"></a>4.2.1 </span><span class="title">Header Attributes</span></div>
                           <div class="body">
                              <p>This section describes attributes of the root ClinicalDocument class. </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			5: Value set for ClinicalDocument.classCode (CNE)
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">Code</th>
                                       <th colspan="1">Definition </th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>DOCCLIN [<strong>default</strong>]
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>A clinical document is a documentation of clinical observations and services, as defined above. </p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			6: Value set for ClinicalDocument.moodCode (CNE)
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">Code</th>
                                       <th colspan="1">Definition</th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>EVN (event) [<strong>default</strong>]
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>An actual occurrence of an event (i.e., the documentation act already happened and is not just a request, intent, plan or
                                          promise to document).
                                          
                                          
                                       </p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_id"></a>4.2.1.1 </span><span class="title">ClinicalDocument.id</span></div>
                                 <div class="body">
                                    <p>Represents the unique instance identifier of a clinical document. </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_code"></a>4.2.1.2 </span><span class="title">ClinicalDocument.code</span></div>
                                 <div class="body">
                                    <p>The code specifying the particular kind of document (e.g. History and Physical, Discharge Summary, Progress Note). The value
                                       set is drawn from LOINC, and has a CWE coding strength. 
                                    </p>
                                    <p>Within the LOINC database, beginning with version 2.09, May 2003, document type codes are those that have a value of "DOC"
                                       in the Scale component. This subset of LOINC is included in the appendix (see <a href="#LOINC_Document_Codes">LOINC Document Codes
                                          			(&sect;
                                          			7.2.2 )</a>).
                                    </p>
                                    <blockquote><b>NOTE: </b>The hierarchical relationship among LOINC document codes is in evolution. Per the LOINC version 2.14 (December 2004) manual:
                                       As soon as possible, the component terms used in the creation of the names of document type codes will be mapped to either
                                       the UMLS Metathesaurus or SNOMED CT. This mapping will help to establish the meaning of the terms and will allow aggregation
                                       and classification of document type codes based on definitions, computable relationships, and subsumption hierarchies that
                                       exist in the reference terminology.
                                    </blockquote>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_title"></a>4.2.1.3 </span><span class="title">ClinicalDocument.title</span></div>
                                 <div class="body">
                                    <p>Represents the title of the document. It's commonly the case that clinical documents do not have a title, and are collectively
                                       referred to by the display name of ClinicalDocument.code (e.g. a "consultation" or "progress note"). Where these display names
                                       are rendered to the clinician, or where the document has a unique title, the ClinicalDocument.title component should be used.
                                       In the example document in the appendix (see <a href="#Sample_Document">Sample Document
                                          			(&sect;
                                          			7.1.1 )</a>), the value of ClinicalDocument.title = "Good Health Clinic Consultation Note".
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_effectiveTime"></a>4.2.1.4 </span><span class="title">ClinicalDocument.effectiveTime</span></div>
                                 <div class="body">
                                    <p>Signifies the document creation time, when the document first came into being. Where the CDA document is a transform from
                                       an original document in some other format, the ClinicalDocument.effectiveTime is the time the original document is created.
                                       The time when the transform occurred is not currently represented in CDA.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_confidentialityCode"></a>4.2.1.5 </span><span class="title">ClinicalDocument.ConfidentialityCode</span></div>
                                 <div class="body">
                                    <p>Confidentiality is a required contextual component of CDA, where the value expressed in the header holds true for the entire
                                       document, unless overridden by a nested value (as further described in <a href="#CDAContext">CDA Context
                                          			(&sect;
                                          			4.4 )</a>).
                                       
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			7: Value set for ClinicalDocument.confidentialityCode (CWE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code *	</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>N (normal) (codeSystem 2.16.840.1.113883.5.25)
                                                
                                                
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Normal confidentiality rules (according to
                                                
                                                good health care practice) apply. That is, only authorized individuals
                                                
                                                with a legitimate medical or business need may access this item.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>R (restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Restricted access, e.g. only to providers having a current care relationship to the patient.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>V (very restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Very restricted access as declared by the Privacy Officer of the record holder.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p>* The codeSystem value is included here because confidentialityCode is of type CE, and therefore must carry both a code and
                                       a codeSystem.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_languageCode"></a>4.2.1.6 </span><span class="title">ClinicalDocument.languageCode</span></div>
                                 <div class="body">
                                    <p>Specifies the human language of character data (whether they be in contents or attribute values). The values of the attribute
                                       are language identifiers as defined by the <a href="http://www.ietf.org/rfc/rfc3066.txt" target="_blank"> IETF (Internet Engineering Task Force) RFC 3066</a> for the Identification of Languages, ed. H. Alvestrand. 1995, which obsoletes RFC 1766. The HL7 code system for these values
                                       is "2.16.840.1.113883.6.121". Language is a contextual component of CDA, where the value expressed in the header holds true
                                       for the entire document, unless overridden by a nested value (as further described in <a href="#CDAContext">CDA Context
                                          			(&sect;
                                          			4.4 )</a>). 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_setId"></a>4.2.1.7 </span><span class="title">ClinicalDocument.setId</span></div>
                                 <div class="body">
                                    <p>Represents an identifier that is common across all document revisions.</p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_versionNumber"></a>4.2.1.8 </span><span class="title">ClinicalDocument.versionNumber</span></div>
                                 <div class="body">
                                    <p>An integer value used to version successive replacement documents. </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ClinicalDocument_copyTime"></a>4.2.1.9 </span><span class="title">ClinicalDocument.copyTime (Deprecated)</span></div>
                                 <div class="body">
                                    <p>Represents the time a document is released (i.e. copied or sent to a display device) from a document management system that
                                       maintains revision control over the document. Once valued, it cannot be changed. The intent is to give the viewer of the document
                                       some notion as to how long the document has been out of the safe context of its document management system. 
                                    </p>
                                    <p>Included for backwards compatibility with CDA, Release One. ClinicalDocument.copyTime has been deprecated because it is not
                                       part of the document at the time it is authenticated, but instead represents metadata about the document, applied at some
                                       variable time after authentication. Further use is discouraged. 
                                    </p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Header_Participants"></a>4.2.2 </span><span class="title">Header Participants</span></div>
                           <div class="body">
                              <p>This section describes classes related to the root ClinicalDocument class via a Participation.</p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="authenticator"></a>4.2.2.1 </span><span class="title">authenticator</span></div>
                                 <div class="body">
                                    <p>Represents a participant who has attested to the accuracy of the document, but who does not have privileges to legally authenticate
                                       the document. An example would be a resident physician who sees a patient and dictates a note, then later signs it. (See also
                                       <a href="#legalAuthenticator">legalAuthenticator
                                          			(&sect;
                                          			4.2.2.8 )</a>) 
                                    </p>
                                    <p>A clinical document can have zero to many authenticators. While electronic signatures are not captured in a CDA document,
                                       both authentication and legal authentication require that a document has been signed manually or electronically by the responsible
                                       individual. An authenticator has a required authenticator.time indicating the time of authentication, and a required authenticator.signatureCode,
                                       indicating that a signature has been obtained and is on file.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			8: Value set for authenticator.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>AUTHEN (authenticator) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A verifier who attests to the accuracy of
                                                
                                                
                                                an act, but who does not have privileges to legally authenticate the
                                                
                                                
                                                
                                                
                                                
                                                
                                                
                                                act. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			9: Value set for authenticator.signatureCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>S (signed)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Signature has been affixed and is on file.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>X (required) (Deprecated)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>CDA Release One represented either an intended ("X") or actual ("S") authenticator. CDA Release Two only represents an actual
                                                authenticator, so has deprecated the value of "X".
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>An authenticator is a person in the role of an assigned entity (AssignedEntity class). An assigned entity is a person assigned
                                       to the role by the scoping organization. The entity playing the role is a person (Person class). The entity scoping the role
                                       is an organization (Organization class). (See <a href="../../infrastructure/rim/rim.htm#Role-cls">here</a> for a description of "player" and "scoper" role associations.)
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			10: Value set for AssignedEntity.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ASSIGNED (Assigned) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An agent role in which the agent is an entity
                                                
                                                acting in the employ of an organization. The focus is on the functional
                                                
                                                role on behalf of the organization.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			11: Value set for Person.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">PSN (person) [<strong>default</strong>] 
                                          </td>
                                          <td colspan="1">A living subject of the species homo sapiens. </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			12: Value set for Person.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (instance) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p> The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			13: Value set for Organization.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ORG (organization) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A social or legal structure formed by human beings.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			14: Value set for Organization.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (Assigned) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p> The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>
                                       
                                       
                                       A scoping organization can be part of a larger organization. Where there is a need to include whole-part relationships, the
                                       OrganizationPartOf role can be used. OrganizationPartOf.statusCode indicates the state of the whole-part relationship (e.g.
                                       "active", "terminated"). OrganizationPartOf.effectiveTime is an interval of time specifying the period during which the whole-part
                                       relationhship is in effect, if such time limit is applicable and known.
                                       
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			15: Value set for OrganizationPartOf.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PART (part) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An association between two Entities where the playing Entity is part of the scoping entity.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			16: Value set for OrganizationPartOf.statusCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>normal (normal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The 'typical' state. Excludes "nullified" which represents the termination state of a Role instance that was created in error.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>active (active)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The state representing the fact that the Entity is currently active in the Role.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>cancelled (cancelled)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The terminal state resulting from cancellation of the role prior to activation.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>pending (pending)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The state representing that fact that the role has not yet become active.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>suspended (suspended)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The state that represents a suspension of the Entity playing the Role. This state is arrived at from the "active" state.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>terminated (terminated)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The state representing the successful termination of the Role.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>nullified (nullified)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The state representing the termination of a Role instance that was created in error.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="author"></a>4.2.2.2 </span><span class="title">author</span></div>
                                 <div class="body">
                                    <p>Represents the humans and/or machines that authored the document. </p>
                                    <p>In some cases, the role or function of the author is inherent in the ClinicalDocument.code, such as where ClinicalDocument.code
                                       is "Medical Student Progress Note". The role of the author can also be recorded in the Author.functionCode or AssignedAuthor.code
                                       attribute. If either of these attributes is included, they should be equivalent to or further specialize the role inherent
                                       in the ClinicalDocument.code (such as where the ClinicalDocument.code is simply "Physician Progress Note" and the value of
                                       Author.functionCode is "rounding physician"), and shall not conflict with the role inherent in the ClinicalDocument.code,
                                       as such a conflict would constitute an ambiguous situation.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			17: Value set for author.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>AUT (author) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A party that originates the Act and therefore has responsibility for the information given in the Act.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			18: Value set for author.contextControlCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                the same typeCode. This overriding association will
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>An author is a person in the role of an assigned author (AssignedAuthor class). The entity playing the role is a person (Person
                                       class) or a device (AuthoringDevice class). The entity scoping the role is an organization (Organization class), and is the
                                       organization from which the document originates.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			19: Value set for AssignedAuthor.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ASSIGNED (assigned entity) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A role in which the playing entity is acting
                                                
                                                
                                                
                                                in the employ of or on behalf of a scoping organization. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			20: Value set for AuthoringDevice.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>DEV (device) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An entity used in an activity, without being
                                                
                                                substantially changed through that activity. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			21: Value set for AuthoringDevice.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (Assigned) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p> The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <blockquote><b>NOTE: </b>In CDA, Release One, it was possible to specify those individuals responsible for the device. This functionality has been
                                       deprecated in CDA, Release Two. The MaintainedEntity class is present for backwards compatibility, and its use is discouraged,
                                       except where needed to support the transformation of CDA, Release One documents. 
                                    </blockquote>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			22: Value set for MaintainedEntity.classCode(CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>MNT (maintained entity) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An entity that is maintained by another entity.
                                                
                                                This is typically a role held by durable equipment. The scoper assumes responsibility
                                                
                                                for proper operation, quality, and safety.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="custodian"></a>4.2.2.3 </span><span class="title">custodian</span></div>
                                 <div class="body">
                                    <p>Represents the organization that is in charge of maintaining the document. The custodian is the steward that is entrusted
                                       with the care of the document. Every CDA document has exactly one custodian.
                                    </p>
                                    <p>The custodian participation satisfies the CDA definition of Stewardship (see <a href="#What_is_the_CDA">What is the CDA
                                          			(&sect;
                                          			1.1 )</a>). Because CDA is an exchange standard and may not represent the original form of the authenticated document, the custodian
                                       represents the steward of the original source document. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			23: Value set for custodian.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>CST (custodian) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An organization that is in charge of maintaining this document.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A custodian is a scoping organization in the role of an assigned custodian (AssignedCustodian class). The steward organization
                                       (CustodianOrganization class) is an entity scoping the role of AssignedCustodian, and has a required CustodianOrganization.id.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			24: Value set for AssignedCustodian.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ASSIGNED (assigned entity) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A role in which the playing entity is acting
                                                
                                                in the employ of or on behalf of a scoping organization. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			25: Value set for CustodianOrganization.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ORG (organization) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A social or legal structure formed by human beings.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			26: Value set for CustodianOrganization.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (Assigned) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="dataEnterer"></a>4.2.2.4 </span><span class="title">dataEnterer (Transcriptionist)</span></div>
                                 <div class="body">
                                    <p>Represents the participant who has transformed a dictated note into text.</p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			27: Value set for dataEnterer.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ENT (transcriptionist) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A person entering the data into the originating
                                                
                                                system. The data entry person is collected optionally for internal quality
                                                
                                                control purposes. This includes the transcriptionist for dictated text.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			28: Value set for dataEnterer.contextControlCode  (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                the same typeCode. This overriding association will
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="EncompasingEncounter_encounterParticipant"></a>4.2.2.5 </span><span class="title">encounterParticipant</span></div>
                                 <div class="body">
                                    <p>See <a href="#EncompassingEncounter">EncompassingEncounter
                                          			(&sect;
                                          			4.2.3.5 )</a> for a description of the encounterParticipant participant.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="informant"></a>4.2.2.6 </span><span class="title">informant</span></div>
                                 <div class="body">
                                    <p>An informant (or source of information) is a person that provides relevant information, such as the parent of a comatose patient
                                       who describes the patient's behavior prior to the onset of coma.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			29: Value set for informant.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INF (informant) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A source of reported information (e.g., a
                                                
                                                next of kin who answers questions about the patient's history).
                                                
                                                For history questions, unless otherwise stated, the patient is implicitly
                                                
                                                the informant.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			30: Value set for informant.contextControlCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                the same typeCode. This overriding association will
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>An informant can be a person in one of two roles. The RelatedEntity role is used to represent an informant without a role.id
                                       (e.g. a parent or guy on the street). The informant in this case bears some formal or personal relationship to the patient.
                                       The role is unscoped, with the assumption that the patient is always the implied scoper. RelatedEntity.code can be used to
                                       specify the nature of the relationship. The AssignedEntity role is used for an identified informant, and is scoped by an Organization.
                                       
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			31: Value set for RelatedEntity.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any subtype of RoleClassMutualRelationship</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A role of an entity that has some mutual
                                                relationship with the patient. The basis of such relationship may be
                                                agreements (e.g., spouses, contract parties) or they may be de facto
                                                behavior (e.g. friends) or may be an incidental involvement with each
                                                other (e.g. parties over a dispute, siblings, children).
                                             </p>
                                             <p>See vocabulary domain "RoleClassMutualRelationship" for allowable values.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="informationRecipient"></a>4.2.2.7 </span><span class="title">informationRecipient</span></div>
                                 <div class="body">
                                    <p>Represents a recipient who should receive a copy of the document.  </p>
                                    <blockquote><b>NOTE: </b>The information recipient is an entity to whom a copy of a document is directed, at the time of document authorship. It is
                                       not the same as the cumulative set of persons to whom the document has subsequently been disclosed, over the life-time of
                                       the patient. Such a disclosure list would not be contained within the document, and it outside the scope of CDA.
                                    </blockquote>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			32: Value set for informationRecipient.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRCP (primary recipient) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Recipient to whom the document is primarily directed. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>TRC (secondary recipient)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A secondary recipient to whom the document is directed. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>Where a person is the intended recipient (IntendedRecipient class), the playing entity is a person (Person class), optionally
                                       scoped by an organization (Organization class). Where the intended recipient is an organization, the IntendedRecipient.classCode
                                       is valued with "ASSIGNED", and the recipient is reflected by the presence of a scoping Organization, without a playing entity.
                                       Where a health chart is the intended recipient, the IntendedRecipient.classCode is valued with "HLTHCHRT" (health chart).
                                       In this case there is no playing entity, and an optional scoping organization (Organization class). 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			33: Value set for IntendedRecipient.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ASSIGNED (assigned entity) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A role in which the playing entity is acting in the employ of or on behalf of a scoping organization. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>HLTHCHRT (health chart)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A role in which the playing entity is a physical
                                                
                                                health chart belonging to the scoping organization.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="legalAuthenticator"></a>4.2.2.8 </span><span class="title">legalAuthenticator</span></div>
                                 <div class="body">
                                    <p>Represents a participant who has legally authenticated the document. </p>
                                    <p>The CDA is a standard that specifies the structure of exchanged clinical documents. In the case where a local document is
                                       transformed into a CDA document for exchange, authentication occurs on the local document, and that fact is reflected in the
                                       exchanged CDA document. A CDA document can reflect the unauthenticated, authenticated, or legally authenticated state. The
                                       unauthenticated state exists when no authentication information has been recorded (i.e., it is the absence of being either
                                       authenticated or legally authenticated).   
                                    </p>
                                    <p>While electronic signatures are not captured in a CDA document, both authentication and legal authentication require that
                                       a document has been signed manually or electronically by the responsible individual. A legalAuthenticator has a required legalAuthenticator.time
                                       indicating the time of authentication, and a required legalAuthenticator.signatureCode, indicating that a signature has been
                                       obtained and is on file.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			34: Value set for legalAuthenticator.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>LA (legal authenticator) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A verifier who legally authenticates the
                                                
                                                
                                                accuracy of an act. An example would be a staff physician who sees a
                                                
                                                patient and dictates a note, then later signs it. Their signature constitutes
                                                
                                                a legal authentication.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			35: Value set for legalAuthenticator.signatureCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>S (signed) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Signature has been affixed and is on file.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>X (required) (Deprecated)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>CDA Release One represented either an intended ("X") or actual ("S") legal authenticator. CDA Release Two only represents
                                                an actual legal authenticator, so has deprecated the value of "X".
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			36: Value set for legalAuthenticator.contextControlCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                the same typeCode. This overriding association will
                                                
                                                
                                                
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A legalAuthenticator is a person in the role of an assigned entity (AssignedEntity class). An assigned entity is a person
                                       assigned to the role by the scoping organization. The entity playing the role is a person (Person class). The entity scoping
                                       the role is an organization (Organization class). 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="participant"></a>4.2.2.9 </span><span class="title">participant</span></div>
                                 <div class="body">
                                    <p>Used to represent other participants not explicitly mentioned by other classes, that were somehow involved in the documented
                                       acts.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			37: Value set for participant.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ParticipationType subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ParticipationType" for allowable values.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			38: Value set for participant.contextControlCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                
                                                the same typeCode. This overriding association will
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A participant is a person or organization in the role of a participating entity (AssociatedEntity class). The entity playing
                                       the role is a person (Person class). The entity scoping the role is an organization (Organization class). 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			39: Value set for AssociatedEntity.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any RoleClassAssociative subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "RoleClassAssociative" for allowable values.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>When the participating entity is an organization, this is reflected by the presence of a scoping Organization, without a playing
                                       entity.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="serviceEvent_performer"></a>4.2.2.10 </span><span class="title">performer</span></div>
                                 <div class="body">
                                    <p>See <a href="#Event">ServiceEvent
                                          			(&sect;
                                          			4.2.3.2 )</a> for a description of the performer participant.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="recordTarget"></a>4.2.2.11 </span><span class="title">recordTarget</span></div>
                                 <div class="body">
                                    <p>The recordTarget represents the medical record that this document belongs to. </p>
                                    <p>A clinical document typically has exactly one recordTarget participant. In the uncommon case where a clinical document (such
                                       as a group encounter note) is placed into more than one patient chart, more than one recordTarget participants can be stated.
                                    </p>
                                    <p>The recordTarget(s) of a document are stated in the header and propagate to nested content, where they cannot be overridden
                                       (see See <a href="#CDAContext">CDA Context
                                          			(&sect;
                                          			4.4 )</a>). 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			40: Value set for recordTarget.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>RCT (record target) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The record target indicates whose medical
                                                
                                                record holds the documentation of this act. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			41: Value set for recordTarget.contextControlCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                the same typeCode. This overriding association will
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A recordTarget is represented as a relationship between a person and an organization, where the person is in a patient role
                                       (PatientRole class). The entity playing the role is a patient (Patient class). The entity scoping the role is an organization
                                       (Organization class). A patient is uniquely identified via the PatientRole.id attribute. 
                                    </p>
                                    <p>CDA Release One allowed for additional person identifiers, corresponding to the Patient.id attribute in CDA Release Two. This
                                       attribute is included for backwards compatibility and has been deprecated because having two different ways to identify a
                                       patient can result in inconsistent usage. Further use of Patient.id is discouraged.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			42: Value set for PatientRole.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PAT (patient) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A person that receives health care services
                                                
                                                from a provider.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			43: Value set for Patient.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PSN (person) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A living subject of the species homo sapiens.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			44: Value set for Patient.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (instance) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A patient's language communication skills can be expressed in the associated LanguageCommunication class. A Patient's birthplace
                                       is represented as a relationship between a patient and a place. The Birthplace class is played by a place (Place class), and
                                       scoped by the patient (Patient class). 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			45: Value set for Birthplace.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>BIRTHPL (birthplace) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Relates a place as the location where a living
                                                
                                                subject was born.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			46: Value set for Place.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition </th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PLC (place) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A physicial place or site with its containing
                                                
                                                structure. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			47: Value set for Place.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (instance) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A patient's guardian is a person or organization in the role of guardian (Guardian class). The entity playing the role of
                                       guardian is a person (Person class) or organization (Organization class). The entity scoping the role is the patient (Patient
                                       class). 
                                    </p>
                                    <p>Where a guardian is not explicitly stated, the value should default to local business practice (e.g. the patient makes their
                                       own health care decisions unless incapacitated in which case healthcare decisions are made by the patient's spouse).
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			48: Value set for Guardian.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>GUARD (guardian) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An entity (player) that acts or is authorized
                                                
                                                to act as the guardian of the patient.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="EncompassingEncounter_responsibleParty"></a>4.2.2.12 </span><span class="title">responsibleParty</span></div>
                                 <div class="body">
                                    <p>See <a href="#EncompassingEncounter">EncompassingEncounter
                                          			(&sect;
                                          			4.2.3.5 )</a> for a description of the responsibleParty participant.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="participation_scenarios"></a>4.2.2.13 </span><span class="title">Participant Scenarios</span></div>
                                 <div class="body">
                                    <p>Several CDA Header participations can be played by the same person. In such cases, the person should be identified as the
                                       player for each appropriate participation. For instance, if a person is both the author and the authenticator of a document,
                                       the CDA Header should identify that person as both the author participant and the authenticator participant.
                                    </p>
                                    <p>On other occasions, CDA Header participants are played by different people. The following table shows a number of scenarios
                                       and the values for various participants. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			49: CDA participation scenarios
                                       </caption>
                                       <tr>
                                          <td colspan="1">1. StaffPhysicianOne sees a patient as a consultant, dictates a note, and later signs it. </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author  &#8212; StaffPhysicianOne</li>
                                                <li>Encounter Participant  &#8212; StaffPhysicianOne (typeCode="CONS")</li>
                                                <li>Legal Authenticator  &#8212; StaffPhysicianOne</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">2. StaffPhysicianOne sees a patient and dictates a note. StaffPhysicianTwo later signs the note. *</td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author &#8212; StaffPhysicianOne </li>
                                                <li>Legal Authenticator  &#8212; StaffPhysicianTwo </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">3. ResidentOne sees a patient with StaffPhysicianOne. ResidentOne dictates a note and later signs it. The note is co-signed
                                             by StaffPhysicianOne. *
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author &#8212; ResidentOne </li>
                                                <li>Authenticator &#8212; ResidentOne </li>
                                                <li>Encounter Participant  &#8212; StaffPhysicianOne (typeCode="ATND")</li>
                                                <li>Legal Authenticator  &#8212; StaffPhysicianOne </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>4. ResidentOne sees a patient with StaffPhysicianOne. ResidentOne dictates a note and later signs it. The note is co-signed
                                                by StaffPhysicianTwo. *
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author &#8212; ResidentOne </li>
                                                <li>Authenticator &#8212; ResidentOne </li>
                                                <li>Encounter Participant  &#8212; StaffPhysicianOne (typeCode="ATND")</li>
                                                <li>Legal Authenticator  &#8212; StaffPhysicianTwo </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">5. ResidentOne sees a patient with StaffPhysicianOne. ResidentOne dictates a note, and goes off on vacation. The note is signed
                                             by ResidentTwo and by StaffPhysicianOne. *
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author &#8212; ResidentOne </li>
                                                <li>Authenticator &#8212; ResidentTwo </li>
                                                <li>Encounter Participant  &#8212; StaffPhysicianOne (typeCode="ATND")</li>
                                                <li>Legal Authenticator  &#8212; StaffPhysicianOne </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>6. ResidentOne sees a patient with StaffPhysicianOne. ResidentOne dictates a note, which is later signed by ResidentTwo and
                                                StaffPhysicianTwo. *
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author &#8212; ResidentOne </li>
                                                <li>Authenticator &#8212; ResidentTwo </li>
                                                <li>Encounter Participant  &#8212; StaffPhysicianOne (typeCode="ATND")</li>
                                                <li>Legal Authenticator  &#8212; StaffPhysicianTwo </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">7. StaffPhysicianOne receives an abnormal lab result, attempts to contact patient but can't, and writes and signs a progress
                                             note.
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author &#8212; StaffPhysicianOne </li>
                                                <li>Legal Authenticator  &#8212; StaffPhysicianOne </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">8. ResidentSurgeonOne is operating on a patient with StaffSurgeonOne. StaffSurgeonOne dictates an operative report and later
                                             signs it.
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <ul>
                                                <li>Author &#8212; StaffSurgeonOne </li>
                                                <li>Authenticator &#8212; null (need not be included) </li>
                                                <li>Legal Authenticator  &#8212; StaffSurgeonOne </li>
                                                <li>Performer &#8212; StaffSurgeonOne (typeCode="PPRF")</li>
                                                <li>Performer &#8212; ResidentSurgeonOne (typeCode="SPRF")</li>
                                             </ul>
                                          </td>
                                       </tr>
                                    </table>
                                    <p>* Note that the ability of one clinician to co-sign or to sign on behalf of another clinician is subject to regulatory and
                                       local practice constraints.
                                    </p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Header_Relationships"></a>4.2.3 </span><span class="title">Header Relationships</span></div>
                           <div class="body">
                              <p>This section describes classes related to the root ClinicalDocument class via an ActRelationship.</p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ParentDocument"></a>4.2.3.1 </span><span class="title">ParentDocument</span></div>
                                 <div class="body">
                                    <p>The ParentDocument represents the source of a document revision, addenda, or transformation. ParentDocument.text is modeled
                                       as an ED data type - allowing for the expression of the MIME type of the parent document. It is not to be used to embed the
                                       related document, and thus ParentDocument.text.BIN is precluded from use. 
                                    </p>
                                    <p>Allowable values for the intervening relatedDocument.typeCode are shown in the following table.  </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			50: Value set for relatedDocument.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>APND (append)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The current document is an addendum to the ParentDocument.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RPLC (replace)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The current document is a replacement of the ParentDocument.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>XFRM (transform)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The current document is a transformation of the ParentDocument.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A conformant CDA document can have a single relatedDocument with typeCode "APND"; a single relatedDocument with typeCode "RPLC";
                                       a single relatedDocument with typeCode "XFRM";  a combination of two relatedDocuments with typeCodes "XFRM" and "RPLC"; or
                                       a combination of two relatedDocuments with typeCodes "XFRM" and "APND". No other combinations are allowed. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			51: Value set for ParentDocument.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>DOCCLIN (clinical document) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A clinical document.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			52: Value set for ParentDocument.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p><strong>Document Identification, Revisions, and Addenda</strong></p>
                                    <p>
                                       
                                       
                                       
                                       A clinical document can be replaced by a new document and/or appended with an addendum. 
                                       
                                       
                                    </p>
                                    <p>A replacement document is a new version of the parent document.  The parent document is considered superseded, but a system
                                       may retain it for historical or auditing purposes. The parent document being replaced is referenced via act relationship relatedDocument,
                                       where relatedDocument.typeCode is set to equal "RPLC" (for "replaces").  An example is a report found to contain an error
                                       that is subsequently replaced by the corrected report.  
                                    </p>
                                    <p>An addendum is a separate document that references the parent document, and may extend or alter the observations in the prior
                                       document.  The parent document remains a current component of the patient record, and the addendum and its parent are both
                                       read by report recipients. The parent report (represented by the ParentDocument class) being appended is referenced via act
                                       relationship relatedDocument, where relatedDocument.typeCode is set to equal "APND" (for "appends"). 
                                    </p>
                                    <p>Every CDA document must have a unique ClinicalDocument.id, and thus the replacement or addendum documents each have ClinicalDocument.id
                                       that is different from that of the parent document. 
                                    </p>
                                    <p>CDA documents may also contain a ClinicalDocument.setId and a ClinicalDocument.versionNumber, which together support a document
                                       identification and versioning scheme used in some document management systems.  In this scheme, all documents in a chain of
                                       replacements have the same ClinicalDocument.setId and are distinguished by an incrementing ClinicalDocument.versionNumber.
                                       The initial version of a document gets, in addition to a new unique value for ClinicalDocument.id, a new value for ClinicalDocument.setId,
                                       and has the value of ClinicalDocument.versionNumber set to equal "1".   A replacement document gets a new globally unique
                                       ClinicalDocument.id value, and uses the same value for ClinicalDocument.setId as the parent report being replaced, and increments
                                       the value of ClinicalDocument.versionNumber by 1. (Note that version number must be incremented by one when a report is replaced,
                                       but can also be incremented more often to meet local requirements.) 
                                    </p>
                                    <p>These relationships are illustrated in the following exhibit "Document Identification, Revisions, and Addenda Scenarios".
                                       Typical scenarios are a simple relacement (e.g. ClinicalDocument.id "1.2.345.6789.266" replacing ClinicalDocument.id "1.2.345.6789.123")
                                       and a simple append (e.g. ClinicalDocument.id "1.2.345.6789.456" appends ClinicalDocument.id "1.2.345.6789.123"). More complex
                                       scenarios that might be anticipated include: [1] replacement of an addendum (e.g. ClinicalDocument.id "1.2.345.6789.224" replaces
                                       ClinicalDocument.id "1.2.345.6789.456", which itself is an addendum to ClinicalDocument.id "1.2.345.6789.123") - expected
                                       behavior would be to render the replacement as the addendum (e.g. render ClinicalDocument.id "1.2.345.6789.224" as the addendum
                                       to ClinicalDocument.id "1.2.345.6789.123"); [2] addendum to a replaced document (e.g. ClinicalDocument.id "1.2.345.6789.456"
                                       appends ClinicalDocument.id "1.2.345.6789.123", which has been replaced by ClinicalDocument.id "1.2.345.6789.266") - expected
                                       behavior would be to render the addendum along with the replacement (e.g. render ClinicalDocument.id "1.2.345.6789.456" as
                                       an addendum to ClinicalDocument.id "1.2.345.6789.266").  
                                    </p>
                                    <p><strong>Document transformations</strong></p>
                                    <p>A CDA document can be a transformation from some other format, meaning that it has undergone a machine translation from some
                                       other format (such as DICOM SR). In this case, relatedDocument.typeCode should be set to "XFRM". 
                                    </p>
                                    <p>A proper transformation must ensure that the human readable clinical content of the report is not impacted. Local business
                                       rules determine whether or not a transformed report replaces the source, but typically this would not be the case. If it is,
                                       an additional relationship of type "RPLC" is to be used. The "XFRM" relationship can also be used when translating a document
                                       in a local format into CDA for the purpose of exchange. In this case, the target of the "XFRM" relationship is the local document
                                       identifier. 
                                    </p>
                                    <table width="90%">
                                       <tr>
                                          <td class="figure"><pre><a href="graphics/L-cda_figure1.gif" target="_blank" border="0">Link to wide graphic (opens in a new window)</a></pre></td>
                                       </tr>
                                    </table>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Event"></a>4.2.3.2 </span><span class="title">ServiceEvent</span></div>
                                 <div class="body">
                                    <p>This class represents the main Act, such as a colonoscopy or an appendectomy, being documented. </p>
                                    <p>In some cases, the ServiceEvent is inherent in the ClinicalDocument.code, such as where ClinicalDocument.code is "History
                                       and Physical Report" and the procedure being documented is a "History and Physical" act. A ServiceEvent can further specialize
                                       the act inherent in the ClinicalDocument.code, such as where the ClinicalDocument.code is simply "Procedure Report" and the
                                       procedure was a "colonoscopy". If ServiceEvent is included, it must be equivalent to or further specialize the value inherent
                                       in the ClinicalDocument.code, and shall not conflict with the value inherent in the ClinicalDocument.code, as such a conflict
                                       would constitute an ambiguous situation.
                                    </p>
                                    <p>ServiceEvent.effectiveTime can be used to indicate the time the actual event (as opposed to the encounter surrounding the
                                       event) took place.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			53: Value set for documentationOf.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>DOC (documents) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The current document is a documentation of the related ServiceEvent.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			54: Value set for ServiceEvent.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ACT (act) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A healthcare service.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ACT subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassRoot" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			55: Value set for ServiceEvent.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>The performer participant represents clinicians who actually and principally carry out the ServiceEvent. Performer.time can
                                       be used to specify the time during which the performer is involved in the activity. Performer.functionCode can be used to
                                       specify addition detail about the function of the performer (e.g. scrub nurse, third assistant). Its value set is drawn from
                                       the ParticipationFunction vocabulary domain, and has a CWE coding strength.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			56: Value set for performer.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRF (performer)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A person who actually and principally carries out an action.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PPRF (primary performer)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The principal performer of the ServiceEvent.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>SPRF (secondary performer)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A person assisting in the ServiceEvent through their substantial presence and involvement. This may include assistants, technicians,
                                                associates, or other performers.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A performer is an entity in the role of assigned entity (AssignedEntity class). An assigned entity is a person assigned to
                                       the role by the scoping organization. The entity playing the role is a person (Person class). The entity scoping the role
                                       is an organization (Organization class). 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Order"></a>4.2.3.3 </span><span class="title">Order</span></div>
                                 <div class="body">
                                    <p>This class represents those orders that are fulfilled by this document. For instance, a provider orders an X-Ray. The X-Ray
                                       is performed. A radiologist reads the X-Ray and generates a report. The X-Ray order identifier is transmitted in the Order
                                       class, the performed X-Ray procedure is transmitted in the ServiceEvent class, and the ClinicalDocument.code would be valued
                                       with "Diagnostic Imaging Report". 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			57: Value set for InFulfillmentOf.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>FLFS (fulfills) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The current document fulfills the order stated in ActOrder.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			58: Value set for Order.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ACT (act) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A healthcare service.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ACT subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassRoot" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			59: Value set for Order.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>RQO (request) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A request or order to perform the stated act.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Consent"></a>4.2.3.4 </span><span class="title">Consent</span></div>
                                 <div class="body">
                                    <p>This class references the consents associated with this document. The type of consent (e.g. a consent to perform the related
                                       ServiceEvent, a consent for the information contained in the document to be released to a third party) is conveyed in Consent.code.
                                       Consents referenced in the CDA Header have been finalized (Consent.statusCode must equal "completed") and should be on file.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			60: Value set for authorization.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code </th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>AUTH (authorized by) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The consent authorizes or certifies acts specified in the current document.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			61: Value set for Conset.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>CONS (consent) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The Consent class represents informed consents and medico-legal transactions.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			62: Value set for Consent.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			63: Value set for Consent.statusCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>completed</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The consent being referenced by the CDA document has been finalized and is on file.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="EncompassingEncounter"></a>4.2.3.5 </span><span class="title">EncompassingEncounter</span></div>
                                 <div class="body">
                                    <p>This optional class represents the setting of the clinical encounter during which the documented act(s) or ServiceEvent occurred.
                                       Documents are not necessarily generated during an encounter, such as when a clinician, in response to an abnormal lab result,
                                       attempts to contact the patient but can't, and writes a Progress Note. 
                                    </p>
                                    <p>In some cases, the setting of the encounter is inherent in the ClinicalDocument.code, such as where ClinicalDocument.code
                                       is "Diabetes Clinic Progress Note". The setting of an encounter can also be transmitted in the HealthCareFacility.code attribute.
                                       If HealthCareFacility.code is sent, it should be equivalent to or further specialize the value inherent in the ClinicalDocument.code
                                       (such as where the ClinicalDocument.code is simply "Clinic Progress Note" and the value of HealthCareFacility.code is "cardiology
                                       clinic"), and shall not conflict with the value inherent in the ClinicalDocument.code, as such a conflict would constitute
                                       an ambiguous situation.  
                                    </p>
                                    <p>EncompassingEncounter.dischargeDispositionCode can be used to depict the disposition of the patient at the time of hospital
                                       discharge (e.g., discharged to home, expired, against medical advice, etc.).  
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			64: Value set for componentOf.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>COMP (component) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The current document is a documentation of events that occurred during the EncompassingEncounter.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			65: Value set for EncompassingEncounter.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ENC (encounter) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An interaction between a patient and healthcare
                                                
                                                participant(s) for the purpose of providing patient service(s) or assessing
                                                
                                                the health status of a patient. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			66: Value set for EncompassingEncounter.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>The location participant (location class) relates a healthcare facility (HealthCareFacility class) to the encounter to indicate
                                       where the encounter took place. The entity playing the role of HealthCareFacility is a place (Place class). The entity  scoping
                                       the HealthCareFacility role is an organization (Organization class). 
                                    </p>
                                    <p>The setting of an encounter (e.g. cardiology clinic, primary care clinic, rehabilitation hospital, skilled nursing facility)
                                       can be expressed in HealthCareFacility.code. Note that setting and physical location are not the same. There is a many-to-many
                                       relationship between setting and the physical location where care is delivered. Thus, a particular room can provide the location
                                       for cardiology clinic one day, and for primary care clinic another day; and cardiology clinic today might be held in one physical
                                       location, but in another physical location tomorrow.
                                    </p>
                                    <p>When the location is an organization, this is indicated by the presence of a scoping Organization, without a playing Place.
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			67: Value set for location.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>LOC (location) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The location where the service is done. May
                                                
                                                
                                                
                                                be a static building (or room therein) or a moving location (e.g., ambulance, helicopter, aircraft, train, truck, ship, etc.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			68: Value set for HealthCareFacility.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>SDLOC (service delivery location) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A role played by a place at which services may be provided.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any SDLOC (RoleClassServiceDeliveryLocation) subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "RollClassServiceDeliveryLocation" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>The responsibleParty participant represents the participant having primary legal responsibility for the encounter. This differs
                                       from the legalAuthenticator participant in that the legalAuthenticator may or may not be the responsible party, and is serving
                                       a medical records function by signing off on the document, moving it into a completed state. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			69: Value set for responsibleParty.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>RESP (responsible party) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The provider (person or organization) who has primary responsibility for the encounter. The responsible provider is not necessarily
                                                present in an encounter, but is accountable for the action through the power to delegate, and the duty to review actions with
                                                the performing participant.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A responsibleParty is a person or organization in the role of an assigned entity (AssignedEntity class). An assigned entity
                                       is a person assigned to the role by the scoping organization. The entity playing the role is a person (Person class). The
                                       entity scoping the role is an organization (Organization class).  
                                    </p>
                                    <p>When the responsible party is an organization, the value for AssignedEntity.classCode is "ASSIGNED", and the responsible party
                                       is reflected by the presence of a scoping Organization, without a playing entity. 
                                    </p>
                                    <p>The encounterParticipant participant represents clinicians directly associated with the encounter (e.g. by initiating, terminating,
                                       or overseeing it).
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			70: Value set for encounterParticipant.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ADM (admitter)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The practitioner who admits a patient to a hospital stay.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>ATND (attender)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The primary practitioner that oversees a patient's care during an encounter.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>CONS (consultant)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>An advising practioner participating in the encounter by performing evaluations and making recommendations.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>DIS (discharger)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The practitioner who discharges a patient from a hospital stay.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>REF (referrer)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A person having referred the patient for services resulting in the encounter.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>An encounterParticipant is an entity in the role of assigned entity (AssignedEntity class). An assigned entity is a person
                                       assigned to the role by the scoping organization. The entity playing the role is a person (Person class). The entity scoping
                                       the role is an organization (Organization class). 
                                    </p>
                                 </div>
                              </div>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Body"></a>4.3 </span><span class="title">Body</span></div>
                     <div class="body">
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Body_Choice"></a>4.3.1 </span><span class="title">Body Choice</span></div>
                           <div class="body">
                              <p>The CDA body can be either an unstructured blob, or can be comprised of structured markup. Every CDA document has exactly
                                 one body, associated with the ClinicalDocument class through the component relationship.
                              </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			71: Value set for component.typeCode (CNE)
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">Code</th>
                                       <th colspan="1">Definition</th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>COMP (component) [<strong>default</strong>]
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>The associated document body is a component of the document.</p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="NonXMLBody"></a>4.3.1.1 </span><span class="title">NonXMLBody</span></div>
                                 <div class="body">
                                    <p>The NonXMLBody class represents a document body that is in some format other than XML. NonXMLBody.text is used to reference
                                       data that is stored externally to the CDA document or to encode the data directly inline.
                                    </p>
                                    <p>Rendering a referenced non-XML body requires a software tool that recognizes the particular MIME media type of the blob. </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			72: Value set for NonXMLBody.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>DOCBODY (document body) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A context that distinguishes the body of a document from the document header. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			73: Value set for NonXMLBody.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of the event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			74: Value set for NonXMLBody.confidentialityCode (CWE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code *</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>N (normal) (codeSystem 2.16.840.1.113883.5.25) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Normal confidentiality rules (according to
                                                
                                                
                                                
                                                
                                                good health care practice) apply. That is, only authorized individuals
                                                
                                                with a legitimate medical or business need may access this item.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>R (restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Restricted access, e.g. only to providers
                                                
                                                
                                                
                                                
                                                
                                                having a current care relationship to the patient.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>V (very restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Very restricted access as declared by the
                                                
                                                Privacy Officer of the record holder.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p>* The codeSystem value is included here because confidentialityCode is of
                                       
                                       type CE, and therefore must carry both a code and a codeSystem.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="StructuredBody"></a>4.3.1.2 </span><span class="title">StructuredBody</span></div>
                                 <div class="body">
                                    <p>The StructuredBody class represents a CDA document body that is comprised of one or more document sections.</p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			75: Value set for StructuredBody.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>DOCBODY (document body) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A context that distinguishes the body of
                                                
                                                a document from the document header. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			76: Value set for StructuredBody.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			77: Value set for StructuredBody.confidentialityCode (CWE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code *</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>N (normal) (codeSystem 2.16.840.1.113883.5.25) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Normal confidentiality rules (according to
                                                
                                                
                                                good health care practice) apply. That is, only authorized individuals
                                                
                                                with a legitimate medical or business need may access this item.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>R (restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Restricted access, e.g. only to providers
                                                
                                                having a current care relationship to the patient.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>V (very restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Very restricted access as declared by the
                                                
                                                Privacy Officer of the record holder.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p>* The codeSystem value is included here because confidentialityCode is of
                                       
                                       type CE, and therefore must carry both a code and a codeSystem.
                                    </p>
                                    <p>The StructuredBody class is associated with one or more Section classes through a component relationship.</p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			78: Value set for component.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>COMP (component) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The associated section is a component of the document body.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Section_Attributes"></a>4.3.2 </span><span class="title">Section Attributes</span></div>
                           <div class="body">
                              <p>Document sections can nest, can override context propagated from the header (see <a href="#CDAContext">CDA Context
                                    			(&sect;
                                    			4.4 )</a>, and can contain narrative and CDA entries. 
                              </p>
                              <p>An XML attribute "ID" of type XML ID, is added to Section within the CDA Schema. This attribute serves as the target of a
                                 &lt;linkHtml&gt; reference (see <a href="#link">&lt;linkHtml&gt;
                                    			(&sect;
                                    			4.3.5.2 )</a>). All values of attributes of type XML ID must be unique within the document (per the <a href="http://www.w3.org/TR/2004/REC-xml-20040204/#id" target="_blank">W3C XML specification</a>).
                              </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			79: Value set for Section.classCode (CNE)
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">Code</th>
                                       <th colspan="1">Definition </th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>DOCSECT (document section) [<strong>default</strong>]
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>A context that subdivides the body of a document.
                                          
                                          Document sections are typically used for human navigation, to give a
                                          
                                          reader a clue as to the expected content. Document sections are used
                                          
                                          to organize and provide consistency to the contents of a document body. 
                                       </p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			80: Value set for Section.moodCode (CNE)
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">Code</th>
                                       <th colspan="1">Definition </th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>EVN (event) [<strong>default</strong>]
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>An actual occurrence of an event. </p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Section_id"></a>4.3.2.1 </span><span class="title">Section.id</span></div>
                                 <div class="body">
                                    <p>The unique instance identifier of a particular document section. </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Section_code"></a>4.3.2.2 </span><span class="title">Section.code</span></div>
                                 <div class="body">
                                    <p>The code specifying the particular kind of section (e.g. Chief Complaint, Review of Systems, Assessment). The value set is
                                       drawn from LOINC, and has a CWE coding strength.
                                       
                                       
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Section_title"></a>4.3.2.3 </span><span class="title">Section.title</span></div>
                                 <div class="body">
                                    <p>Represents the label of a section. If valued, it is to be rendered as part of the narrative content of the clinical document
                                       body. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Section_text"></a>4.3.2.4 </span><span class="title">Section.text</span></div>
                                 <div class="body">
                                    <p>Used to store narrative to be rendered. Also referred to as the CDA Narrative Block. See <a href="#CDA_Section_Narrative_Block">Section Narrative Block
                                          			(&sect;
                                          			4.3.5 )</a> for details. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Section_confidentialityCode"></a>4.3.2.5 </span><span class="title">Section.confidentialityCode</span></div>
                                 <div class="body">
                                    <p>A value for Section.confidentialityCode overrides the value propagated from StructuredBody. See <a href="#CDAContext">CDA Context
                                          			(&sect;
                                          			4.4 )</a> for more details. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			81: Value set for Section.confidentialityCode (CWE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code*</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>N (normal) (codeSystem 2.16.840.1.113883.5.25) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Normal confidentiality rules (according to
                                                
                                                good health care practice) apply. That is, only authorized individuals
                                                
                                                
                                                with a legitimate medical or business need may access this item.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>R (restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Restricted access, e.g. only to providers
                                                
                                                having a current care relationship to the patient.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>V (very restricted) (codeSystem 2.16.840.1.113883.5.25)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Very restricted access as declared by the
                                                
                                                Privacy Officer of the record holder.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p>* The codeSystem value is included here because confidentialityCode is of type CE, and therefore must carry both a code and
                                       a codeSystem.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Section_languageCode"></a>4.3.2.6 </span><span class="title">Section.languageCode</span></div>
                                 <div class="body">
                                    <p>Specifies the human language of character data (whether they be in contents or attribute values). The values of the attribute
                                       are language identifiers as defined by the <a href="http://www.ietf.org/rfc/rfc3066.txt" target="_blank">IETF (Internet Engineering Task Force) RFC 3066: Tags for the Identification of Languages, ed. H. Alvestrand. 1995</a> , which obsoletes RFC 1766. The HL7 code system for these values is "2.16.840.1.113883.6.121".
                                    </p>
                                    <p>A value for Section.languageCode overrides the value propagated from StructuredBody. See <a href="#CDAContext">CDA Context
                                          			(&sect;
                                          			4.4 )</a> for more details. 
                                    </p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Section_Participants"></a>4.3.3 </span><span class="title">Section Participants</span></div>
                           <div class="body">
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="section_author"></a>4.3.3.1 </span><span class="title">author</span></div>
                                 <div class="body">
                                    <p>The author participant (described above, see <a href="#author">author
                                          			(&sect;
                                          			4.2.2.2 )</a>), can be ascribed to a CDA section, where it overrides the value(s) propagated from the CDA header. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="section_informant"></a>4.3.3.2 </span><span class="title">informant</span></div>
                                 <div class="body">
                                    <p>The informant participant (described above, see <a href="#informant">informant
                                          			(&sect;
                                          			4.2.2.6 )</a>), can be ascribed to a CDA section where it overrides the value(s) propagated from the CDA header. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="section_subject"></a>4.3.3.3 </span><span class="title">subject</span></div>
                                 <div class="body">
                                    <p>The subject participant represents the primary target of the entries recorded in the document. Most of the time the subject
                                       is the same as the recordTarget (see <a href="#recordTarget">recordTarget
                                          			(&sect;
                                          			4.2.2.11 )</a>), but need not be, for instance when the subject is a fetus observed in an obstetrical ultrasound.  
                                    </p>
                                    <p>The subject participant can be ascribed to a CDA section or a CDA entry. It propagates to nested components, unless overridden.
                                       The subject of a document is presumed to be the patient.  
                                    </p>
                                    <p>A subject is a person playing one of several possible roles (RelatedSubject class). The entity playing the role is a person
                                       (SubjectPerson class). 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			82: Value set for subject.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>SBJ (subject) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The principle target that the service acts
                                                
                                                
                                                on. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			83: Value set for subject.contextControlCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                the same typeCode. This overriding association will
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			84: Value set for RelatedSubject.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRS (personal relationship) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The subject has a personal relationship to
                                                
                                                the patient. The type of personal relationship is stated in SubjectRole.code,
                                                
                                                with a value drawn from the extensible (CWE) PersonalRelationshipRoleType
                                                
                                                vocabulary domain. The scoper is always the patient, and is implied.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PAT (patient)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The subject of an entry is the patient, who
                                                
                                                is identified in the recordTarget participant in the CDA header. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			85: Value set for SubjectPerson.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PSN (person) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A living subject of the species homo sapiens.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			86: Value set for SubjectPerson.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (instance) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Section_Relationships"></a>4.3.4 </span><span class="title">Section Relationships</span></div>
                           <div class="body">
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="component"></a>4.3.4.1 </span><span class="title">component</span></div>
                                 <div class="body">
                                    <p>The "component" Act Relationship is used to nest a Section within a Section. Context propagates to nested sections (see <a href="#CDAContext">CDA Context
                                          			(&sect;
                                          			4.4 )</a>). 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			87: Value set for component.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>COMP (component) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The nested section is a component of the outer section.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry"></a>4.3.4.2 </span><span class="title">entry</span></div>
                                 <div class="body">
                                    <p>The relationship between a section and its entries is encoded in the intervening "entry" Act Relationship. </p>
                                    <blockquote><b>NOTE: </b>See <a href="#XML_ID_IDREFS_Pointers">Referencing in and out of the narrative block
                                          			(&sect;
                                          			4.3.5.12 )</a> for a discussion of referencing in and out of a section's narrative block.
                                    </blockquote>
                                    <p>The narrative of each Section, together with the multimedia content referenced in the narrative, comprises the complete authenticated
                                       content of the Section. This multimedia content consists of ObservationMedia and RegionOfInterest entries referenced by &lt;renderMultimedia&gt;
                                       tags in the Section.text. This is the only case where the entries contain authenticated content that must be rendered with
                                       the narrative. 
                                    </p>
                                    <p>In terms of the relationship between a section and its entries, CDA defines a default general case, and a more specific case
                                       that can be used when applicable.
                                    </p>
                                    <p>The entry relationship is defaulted to "COMP" (component), for the general case where the only assertion is that the related
                                       entries are contained within the source section and no other semantics are implied. In this case, the narrative is the original
                                       authenticated content. The CDA entries are created by various techniques (e.g., natural language processing, a human coder,
                                       a structured data entry tool that outputs both entries and a text report). The method of entry creation may be indicated by
                                       the entry participants (e.g., by identifying the algorithm or person that generated them). Relationships between various entries
                                       (such as two Observations or an Observation and an ObservationMedia) are encoded using the relationship types defined in <a href="#entryRelationship">entryRelationship
                                          			(&sect;
                                          			4.3.8.4 )</a>.
                                       
                                       
                                    </p>
                                    <p>A section may also have no narrative content in the case where the entries represent information that is not part of the clinical
                                       content of the document.  A report may embed information referencing evidence data, reagents, calibration or other information
                                       that may be used for later processing but is not part of the clinical content.  Such entries are also linked to the Section
                                       with ActRelationships possessing typeCode="COMP".
                                    </p>
                                    <p>The entry relationship "DRIV" (is derived from) can be used in the special case where the narrative is fully derived from
                                       CDA Entries.  When a report consisting entirely of structured entries is transformed into CDA, the encoding application must
                                       ensure that the authenticated content (narrative plus multimedia) is a faithful and complete rendering of the clinical content
                                       of the structured source data. This ensures that the narrative plus multimedia represents, as in all CDA documents, the complete
                                       authenticated content of the Section.  In this case, narrative plus multimedia does not contain any clinical content that
                                       is not present in the Entries.  An example of this case is a DICOM Structured Reporting document of obstetrical measurements
                                       made by ultrasound, rendered into a tabular report by a program converting it to CDA narrative block. If the typeCode of the
                                       ActRelationship linking these Entries to the Section was "DRIV", it would indicate to a receiving application: 1) the source
                                       of the narrative block is the Entries; 2) the contents of the two are equivalent. 
                                    </p>
                                    <p>The entries sourced from a Section may have a mix of ActRelationship typeCodes. In such a case, the union of the targets with
                                       a "DRIV" relationship are those used to generate the narrative block, and are those that, taken in total, are equivalent to
                                       the narrative block. Additional entries with "COMP" relationships are contained within the same section, with no implied semantics.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			88: Value set for entry.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>COMP (component) [<strong>default</strong>] 
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The associated entry is a component of the section. No semantic relationship is implied.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>DRIV (is derived from)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The narrative was rendered from the CDA Entries, and contains no clinical content not derived from the entries.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Section_Narrative_Block"></a>4.3.5 </span><span class="title">Section Narrative Block</span></div>
                           <div class="body">
                              <p>The Section.text field is used to store narrative to be rendered, as described above in <a href="#CDA_Conformance">CDA Conformance
                                    			(&sect;
                                    			1.3 )</a>, and is therefore referred to as the CDA Narrative Block.
                              </p>
                              <p><a href="../../processable/coreschemas/NarrativeBlock.xsd" target="_blank">The CDA Narrative Block schema can be found here.</a></p>
                              <p>The content model of the CDA Narrative Block schema is specially hand crafted to meet the requirements outlined above (see
                                 <a href="#Human_Readability_and_Rendering_CDA_Documents">Human Readability and Rendering CDA Documents
                                    			(&sect;
                                    			1.2.3 )</a>). The schema is registered as a MIME type (text/x-hl7-text+xml), which is the fixed media type for Section.text. Components
                                 of the schema are described in the sections that follow. 
                              </p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="content"></a>4.3.5.1 </span><span class="title">&lt;content&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;content&gt; element is used to wrap a string of text so that it can be explicitly referenced, or so that it can suggest
                                       rendering characteristics. The &lt;content&gt; element can nest recursively, which enables wrapping a string of plain text down
                                       to as small a chunk as desired. 
                                    </p>
                                    <p>The &lt;content&gt; element contains an optional identifier, that can serve as the target of a reference. All values of attributes
                                       of type XML ID must be unique within the document (per the <a href="http://www.w3.org/TR/2004/REC-xml-20040204/#id" target="_blank">W3C XML specification</a>). The originalText component of a RIM attribute present in any CDA entry can make explicit reference to the identifier, thereby
                                       indicating the original text associated with the attribute in the CDA entry. 
                                    </p>
                                    <table width="90%">
                                       <caption>Example 5. Referencing into the CDA Narrative Block</caption>
                                       <tr>
                                          <td class="example"><pre><pre>
&lt;section&gt;
   &lt;code code="10153-2" 
    codeSystem="2.16.840.1.113883.6.1" 
    codeSystemName="LOINC"/&gt;
   &lt;title&gt;Past Medical History&lt;/title&gt;
   &lt;text&gt;
    There is a history of &lt;content ID="a1"&gt;Asthma&lt;/content&gt;
   &lt;/text&gt;
   &lt;entry&gt;
      &lt;observation classCode="OBS" moodCode="EVN"&gt;
         &lt;code code="195967001" 
          codeSystem="2.16.840.1.113883.6.96" 
          codeSystemName="SNOMED CT" 
          displayName="Asthma"&gt;
            &lt;originalText&gt;
               &lt;reference value="#a1"/&gt;
            &lt;/originalText&gt;
         &lt;/code&gt;
         &lt;statusCode code="completed"/&gt;
      &lt;/observation&gt;
   &lt;/entry&gt;
&lt;/section&gt;
</pre></pre></td>
                                       </tr>
                                    </table>
                                    <p>There is no requirement that CDA entries must reference into the CDA Narrative Block. The referencing mechanism can be used
                                       where it is important to represent the original text component of a coded CDA entry. 
                                    </p>
                                    <p>The &lt;content&gt; element contains an optional "revised" attribute that can be valued with "insert" or "delete", which can be
                                       used to indicate narrative changes from the last version of a CDA document. The attribute is limited to a single generation,
                                       in that it only reflects the changes from the preceding version of a document. If applied, it needs to be used in conjunction
                                       with standard CDA revision tracking. Changes to a CDA document that has been released for patient care still require a formal
                                       versioning and revision, and the revised document can optionally carry the "revised" attribute to show the delta in the narrative.
                                       Receivers are required to interpret the "revised" attribute when rendering by visually distinguishing or suppressing deleted
                                       narrative. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="link"></a>4.3.5.2 </span><span class="title">&lt;linkHtml&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;linkHtml&gt; is a generic referencing mechanism, similar, but not identical, to the HTML anchor tag. It can be used
                                       to reference identifiers that are either internal or external to the document.
                                    </p>
                                    <p>Multimedia that is integral to a document, and part of the attestable content of the document requires the use of the ObservationMedia
                                       CDA entry, which is referenced by the &lt;renderMultiMedia&gt; element (see <a href="#renderMultiMedia">&lt;renderMultiMedia&gt;
                                          			(&sect;
                                          			4.3.5.6 )</a>). Multimedia that is simply referenced by the document and not an integral part of the document can use &lt;linkHtml&gt;. 
                                    </p>
                                    <p>The source of a link uses the linkHtml.href attribute. The target of an internal reference is an identifier of type XML ID,
                                       which can exist on other elements in the same or a different narrative block, or XML ID attributes that have been added to
                                       the &lt;section&gt;, &lt;ObservationMedia&gt;, or &lt;renderMultiMedia&gt; elements of the CDA Schema. The linkHtml.name attribute is deprecated,
                                       because attributes of type XML ID provide an alternative and more consistent target for referencing. Following the conventions
                                       of HTML, an internal link is prefaced with the pound sign, as shown in the following example.
                                    </p>
                                    <table width="90%">
                                       <caption>Example 6. Illustration of linkHtml referencing</caption>
                                       <tr>
                                          <td class="example"><pre><pre>
&lt;section ID="SECT001"&gt;
   &lt;code code="10164-2" codeSystem="2.16.840.1.113883.6.1" 
    codeSystemName="LOINC"/&gt;
   &lt;title&gt;History of Present Illness&lt;/title&gt;
   &lt;text&gt;Mr. Smith is a 57 year old male presenting with 
    chest pain. He sustained a myocardial infarction 3 years 
    ago, ...
   &lt;/text&gt;
&lt;/section&gt;

...

&lt;section ID="SECT003"&gt;
   &lt;code code="10153-2" codeSystem="2.16.840.1.113883.6.1" 
    codeSystemName="LOINC"/&gt;
   &lt;title&gt;Past Medical History&lt;/title&gt;
   &lt;text&gt;History of coronary artery disease, as noted
    &lt;linkHtml href="#SECT001"&gt;above&lt;/linkHtml&gt;.&lt;/text&gt;
&lt;/section&gt;
</pre></pre></td>
                                       </tr>
                                    </table>
                                    <p>CDA links do not convey shareable meaning. Shareable semantics are only achieved by the inclusion of CDA entries and their
                                       associated formalized relationships. There is no requirement that a receiver render an internal or external link, or the target
                                       of an external link.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="sub_and_sup"></a>4.3.5.3 </span><span class="title">&lt;sub&gt; and &lt;sup&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;sub&gt; and &lt;sup&gt; elements are used to indicate subscripts and superscripts, respectively. </p>
                                    <p>Receivers are required to interpret these elements when rendering by visually distinguishing subscripted and superscripted
                                       characters.
                                       
                                       
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="br"></a>4.3.5.4 </span><span class="title">&lt;br&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;br/&gt; element is used to indicate a hard line break. It differs from the CDA &lt;paragraph&gt; element in that the &lt;br/&gt;
                                       element has no content. Receivers are required to interpret this element when rendering so as to represent a line break. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="footNote"></a>4.3.5.5 </span><span class="title">&lt;footnote&gt; and &lt;footnoteRef&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;footnote&gt; element is used to indicate a footnote. The element contains the footnote, inline with the flow of text
                                       to which it is applied. 
                                       
                                       
                                    </p>
                                    <p>The &lt;footnoteRef&gt; element can reference an existing footnote in the same or different CDA Narrative Block of the same document.
                                       It can be used when the same footnote is being used multiple times. The value of the footnoteRef.IDREF must be an footnote.ID
                                       value in the same document.
                                       
                                       
                                       
                                       
                                       
                                       
                                    </p>
                                    <p>Receivers are required to interpret these elements when rendering by visually distinguishing footnoted text. The exact rendition
                                       is at the discretion of the recipient, and might include a mark at the location of the footnote with a hyperlink to the footnoted
                                       text, a simple demarcation (such as "This is the text [this is the footnote] that is being footnoted"), etc. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="renderMultiMedia"></a>4.3.5.6 </span><span class="title">&lt;renderMultiMedia&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;renderMultiMedia&gt; element references external multimedia that is integral to a document, and part of the attestable
                                       content of the document, and serves to show where the referenced multimedia is to be rendered. 
                                    </p>
                                    <p>The &lt;renderMultiMedia&gt; element has an optional &lt;caption&gt;, and contains a required referencedObject attribute (of type XML
                                       IDREFS), the values of which must equal the XML ID value(s) of ObservationMedia or RegionOfInterest CDA entries within the
                                       same document.
                                    </p>
                                    <table width="90%">
                                       <caption>Example 7. Referencing attested multimedia from within the CDA Narrative Block</caption>
                                       <tr>
                                          <td class="example"><pre><pre>
&lt;section&gt;
   &lt;code code="8709-8" codeSystem="2.16.840.1.113883.6.1" 
    codeSystemName="LOINC"/&gt;
   &lt;title&gt;Skin exam&lt;/title&gt;
   &lt;text&gt;Erythematous rash, palmar surface, left index 
    finger.&lt;renderMultiMedia referencedObject="MM1"/&gt;
   &lt;/text&gt;
   &lt;entry&gt;
      &lt;observationMedia classCode="OBS" moodCode="EVN" ID="MM1"&gt;
         &lt;id root="2.16.840.1.113883.19.2.1"/&gt;
         &lt;value xsi:type="ED" mediaType="image/jpeg"&gt;
            &lt;reference value="left_hand_image.jpeg"/&gt;
         &lt;/value&gt;
      &lt;/observationMedia&gt;
   &lt;/entry&gt;
&lt;/section&gt;
</pre></pre></td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>Multimedia that is simply referenced by the document and not an integral part of the document must use &lt;linkHtml&gt;.</p>
                                    <p>The expected behavior is that the referenced multimedia should be rendered or referenced at the point of reference. Where
                                       a caption is present, it must also be rendered.
                                       
                                       &lt;renderMultiMedia&gt; can either reference a single ObservationMedia, or one or more RegionOfInterest. If &lt;renderMultiMedia&gt;
                                       references a single ObservationMedia, that ObservationMedia should be rendered or referenced at the point of reference. If
                                       &lt;renderMultiMedia&gt; references one or more RegionOfInterest, all RegionOfInterests should be rendered or referenced at the
                                       point of reference, atop the multimedia they are regions of. If &lt;renderMultiMedia&gt; references more than one RegionOfInterest,
                                       each RegionOfInterest must be a region on the same multimedia.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="paragraph"></a>4.3.5.7 </span><span class="title">&lt;paragraph&gt;</span></div>
                                 <div class="body">
                                    <p>A CDA &lt;paragraph&gt; is similar to the HTML paragraph, which allows blocks of narrative to be broken up into logically consistent
                                       structures. A CDA &lt;paragraph&gt; element contains an optional caption, which if present must come first before any other character
                                       data. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="list"></a>4.3.5.8 </span><span class="title">&lt;list&gt;</span></div>
                                 <div class="body">
                                    <p>A CDA &lt;list&gt; is similar to the HTML list. A CDA &lt;list&gt; has an optional caption, and contains one or more &lt;item&gt; elements.
                                       A CDA &lt;item&gt; element contains an optional caption, which if present must come first before any other character data. The required
                                       listType attribute specifies whether the &lt;list&gt; is ordered or unordered (with unordered being the default). Unordered lists
                                       are typically rendered with bullets, whereas ordered lists are typically rendered with numbers, although this is not a requirement.
                                       
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="table"></a>4.3.5.9 </span><span class="title">&lt;table&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;table&gt; is similar to the HTML table. The table markup is for presentation purposes only and, unlike a database table,
                                       does not possess meaningful field names. 
                                    </p>
                                    <p>CDA modifies the strict XHTML table model by removing formatting tags and by setting the content model of cells to be similar
                                       to the contents of other elements in the CDA Narrative Block. 
                                    </p>
                                    <p>
                                       
                                       The table.border, table.cellspacing, and table.cellpadding attributes are deprecated, because the styleCode attribute (see
                                       <a href="#styleCode">styleCode attribute
                                          			(&sect;
                                          			4.3.5.11 )</a> provides a more consistent way for senders to suggest rendering characteristics. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="caption"></a>4.3.5.10 </span><span class="title">&lt;caption&gt;</span></div>
                                 <div class="body">
                                    <p>The CDA &lt;caption&gt; is a label for a paragraph, list, list item, table, or table cell. It can also be used within the &lt;renderMultiMedia&gt;
                                       element to indicate a label for referenced ObservationMedia and RegionOfInterest entries. A &lt;caption&gt; contains plain text
                                       and may contain links and footnotes.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="styleCode"></a>4.3.5.11 </span><span class="title">styleCode attribute</span></div>
                                 <div class="body">
                                    <p>The styleCode attribute is used within the CDA Narrative Block to give the instance author the ability to suggest rendering
                                       characteristics of the nested character data. Receivers are not required to render documents using the style hints provided
                                       and can present stylized text in accordance with their local style conventions.
                                    </p>
                                    <p>
                                       
                                       The value set is drawn from the HL7 styleType vocabulary domain, and has a CWE coding strength.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			89: Value set for styleCode (CWE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="2">
                                             <p>Font style (Defines font rendering characteristics.)</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Bold</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render with a bold font.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Underline</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render with an underlines font.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Italics</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render italicized.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Emphasis</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render with some type of emphasis.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="2">
                                             <p>Table rule style (Defines table cell rendering characteristics.)</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Lrule</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render cell with left-sided rule.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Rrule</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render cell with right-sided rule.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Toprule</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render cell with rule on top.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Botrule</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Render cell with rule on bottom.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="2">
                                             <p>Ordered list style (Defines rendering characteristics for ordered lists.)</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Arabic</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List is ordered using Arabic numerals: 1, 2, 3.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>LittleRoman</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List is ordered using little Roman numerals: i, ii, iii.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>BigRoman</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List is ordered using big Roman numerals: I, II, III.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>LittleAlpha</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List is ordered using little alpha characters: a, b, c.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>BigAlpha</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List is ordered using big alpha characters: A, B, C.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="2">
                                             <p>Unordered list style (Defines rendering characteristics for unordered lists.)</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Disc</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List bullets are simple solid discs.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Circle</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List bullets are hollow discs.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Square</p>
                                          </td>
                                          <td colspan="1">
                                             <p>List bullets are solid squares.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>Local extensions to the styleType vocabulary domain must follow the following convention: [x][A-Za-z][A-Za-z0-9]* (first character
                                       is "x", second character is an upper or lower case A-Z, remaining characters are any combination of upper and lower case letters
                                       or numbers).
                                       
                                       
                                    </p>
                                    <p>
                                       
                                       The styleCode attribute can contain multiple values, separated by white space. Where an element containing a styleCode attribute
                                       is nested within another element containing a styleCode attribute, the style effects are additive, as in the following example:
                                    </p>
                                    <table width="90%">
                                       <caption>Example 8. Illustration of the styleCode attribute</caption>
                                       <tr>
                                          <td class="example"><pre><pre>
&lt;section&gt;
   &lt;text&gt;&lt;content styleCode="Bold"&gt;This is rendered bold, 
    &lt;content styleCode="Italics"&gt;this is rendered bold and 
    italicized,&lt;/content&gt; this is rendered bold. &lt;/content&gt;
    &lt;content styleCode="Bold Italics"&gt;This is also rendered 
    bold and italicized.&lt;/content&gt;
   &lt;/text&gt;
&lt;/section&gt;
</pre></pre></td>
                                       </tr>
                                    </table>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="XML_ID_IDREFS_Pointers"></a>4.3.5.12 </span><span class="title">Referencing in and out of the narrative block</span></div>
                                 <div class="body">
                                    <blockquote><b>NOTE: </b>See <a href="#entry">entry
                                          			(&sect;
                                          			4.3.4.2 )</a> for a discussion of the relationships between a section and its contained entries.
                                    </blockquote>
                                    <p>To summarize the mechanisms for referencing in and out of the CDA Narrative Block: 
                                       
                                       
                                       <ul style="margin-left:20px;">
                                          <li>CDA entries can point in to the &lt;content&gt; element of the CDA Narrative Block (see <a href="#content">&lt;content&gt;
                                                			(&sect;
                                                			4.3.5.1 )</a>).
                                          </li>
                                          <li>The &lt;linkHtml&gt; element of the CDA Narrative Block can reference targets that are either internal or external to the document
                                             (see <a href="#link">&lt;linkHtml&gt;
                                                			(&sect;
                                                			4.3.5.2 )</a>).
                                          </li>
                                          <li>The &lt;footnoteRef&gt; element of the CDA Narrative Block can reference a &lt;footnote&gt; element in the same or different CDA Narrative
                                             Block of the same document (see <a href="#footNote">&lt;footnote&gt; and &lt;footnoteRef&gt;
                                                			(&sect;
                                                			4.3.5.5 )</a>).
                                             
                                             
                                             
                                          </li>
                                          <li>The &lt;renderMultiMedia&gt; element of the CDA Narrative Block can point out to CDA ObservationMedia and RegionOfInterest entries
                                             of the same document (see <a href="#renderMultiMedia">&lt;renderMultiMedia&gt;
                                                			(&sect;
                                                			4.3.5.6 )</a>).
                                          </li>
                                       </ul>
                                    </p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Entry_Acts"></a>4.3.6 </span><span class="title">Entry Acts</span></div>
                           <div class="body">
                              <p>CDA entries represent the structured computer-processable components within a document section. Each section can contain zero
                                 to many entries. 
                              </p>
                              <p>Clinical documents contain a wide breadth of content, requiring much of the RIM to enable a full and complete encoding. The
                                 current set of CDA entries have been developed in response to identified requirements and scenarios that are in CDA's scope.
                                 Rather than creating specific entries for each scenario, similar requirements are merged to create broader entries, which
                                 can then be constrained within a particular realm or implementation. This approach is consistent with the approach taken by
                                 CEN, DICOM, and OpenEHR.
                              </p>
                              <p>The model for CDA entries is derived from the shared HL7 Clinical Statement model, which is a collaborative project between
                                 several committees striving to provide a consistent representation of clinical observations and acts across various V3 specifications.
                              </p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Act"></a>4.3.6.1 </span><span class="title">Act</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM Act class, to be used when the other more specific classes aren't appropriate.  </p>
                                    <p>Act.negationInd, when set to "true", is a positive assertion that the Act as a whole is negated. Some properties such as Act.id,
                                       Act.moodCode, and the participations are not affected. These properties always have the same meaning: i.e., the author remains
                                       the author of the negative Act. An act statement with negationInd is still a statement about the specific fact described by
                                       the Act. For instance, a negated "finding of wheezing on July 1" means that the author positively denies that there was wheezing
                                       on July 1, and that he takes the same responsibility for such statement and the same requirement to have evidence for such
                                       statement than if he had not used negation. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			90: Value set for Act.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ACT (act)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A healthcare service.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>ACCM (accommodation)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>An accommodation is a service provided for a Person or other LivingSubject in which a place is provided for the subject to
                                                reside for a period of time.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>CONS (consent)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Represents informed consents and other medico-legal transactions between the patient (or legal guardian) and the provider.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>CTTEVENT (clinical trial timepoint event)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>An identified point during a clinical trial at which one or more actions are scheduled to be performed (definition mood),
                                                or are actually performed (event mood).
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>INC (incident)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>An event that occurred outside of the control of one or more of the parties involved. Includes the concept of an accident.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>INFRM (inform)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The act of transmitting information and understanding about a topic (or requesting that such information be transmitted) to
                                                a subject.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PCPR (care provision)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A patient care provision is the taking on of the responsibility by a performer for the health care of a patient or group of
                                                patients.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>REG (registration)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>Represents the act of maintaining information about an entity or role in a registry.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>SPCTRT (specimen treatment)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A procedure or treatment performed on a specimen to prepare it for analysis</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			91: Value set for Act.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>INT (intent)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is intended or planned.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>APT (appointment)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is planned for a specific time and place.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>ARQ (appointment request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is a request for the booking of an appointment.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRMS (promise)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A commitment to perform the stated entry.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRP (proposal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A proposal that the stated entry be performed.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RQO (request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A request or order to perform the stated entry. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>DEF (definition)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines a service (master). </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Encounter"></a>4.3.6.2 </span><span class="title">Encounter</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM PatientEncounter class, used to represent related encounters, such as follow-up visits or referenced
                                       past encounters.  
                                    </p>
                                    <blockquote><b>NOTE: </b>The EncompassingEncounter class in the CDA Header (see <a href="#CDA_Header_Relationships">Header Relationships
                                          			(&sect;
                                          			4.2.3 )</a>) represents the setting of the clinical encounter during which the documented act occurred. The Encounter class in the CDA
                                       Body is used to represent other related encounters.
                                    </blockquote>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			92: Value set for Encounter.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ENC (encounter) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An interaction between a patient and healthcare
                                                
                                                participant(s) for the purpose of providing patient service(s) or assessing
                                                
                                                the health status of a patient.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			93: Value set for Encounter.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INT (intent) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is intended or planned. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>APT (appointment)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is planned for a specific time and place.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>ARQ (appointment request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is a request for the booking of an appointment.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRMS (promise)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A commitment to perform the stated entry.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRP (proposal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A proposal that the stated entry be performed.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RQO (request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A request or order to perform the stated entry. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Observation"></a>4.3.6.3 </span><span class="title">Observation</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM Observation class, used for representing coded and other observations.  </p>
                                    <p>Observation.negationInd, when set to "true", is a positive assertion that the Observation as a whole is negated. Some properties
                                       such as Observation.id, Observation.moodCode, and the participations are not negated. These properties always have the same
                                       meaning: i.e., the author remains the author of the negative Observation. An observation statement with negationInd is still
                                       a statement about the specific fact described by the Observation. For instance, a negated "finding of wheezing on July 1"
                                       means that the author positively denies that there was wheezing on July 1, and that he takes the same responsibility for such
                                       statement and the same requirement to have evidence for such statement than if he had not used negation. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			94: Value set for Observation.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OBS (observation) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Observations are actions performed in order
                                                
                                                to determine an answer or result value. 
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any OBS subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassObservation" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			95: Value set for Observation.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>DEF (definition)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry serves to define an observation.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>GOL (goal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry represents a goal or objective.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>INT (intent)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is intended or planned.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRMS (promise)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A commitment to perform the stated entry.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRP (proposal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A proposal that the stated entry be performed.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RQO (request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A request or order to perform the stated entry. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>An Observation can have zero to many referenceRange relationships, which relate an Observation to the ObservationRange class,
                                       where the expected range of values for a particular observation can be specified.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			96: Value set for referenceRange.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>REFV (has reference values) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Reference ranges are essentially descriptors
                                                
                                                of a class of result values assumed to be "normal", "abnormal",
                                                
                                                or "critical". This link type can act as a trigger in case
                                                
                                                
                                                
                                                
                                                
                                                of alarms being triggered by critical results.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			97: Value set for ObservationRange.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OBS (observation) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Observations are actions performed in order
                                                
                                                
                                                to determine an answer or result value. 
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any OBS subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassObservation" for allowable values.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			98: Value set for ObservationRange.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN.CRT (event criterion) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A criterion or condition over observations
                                                
                                                
                                                
                                                that must apply for an associated service to be considered.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="ObservationMedia"></a>4.3.6.4 </span><span class="title">ObservationMedia</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM Observation class that represents multimedia that is logically part of the current document. This
                                       class is only for multimedia that is logically part of the attested content of the document. Rendering a referenced ObservationMedia
                                       requires a software tool that recognizes the particular MIME media type. 
                                    </p>
                                    <p>An XML attribute "ID" of type XML ID, is added to ObservationMedia within the CDA Schema. This attribute serves as the target
                                       of a &lt;renderMultiMedia&gt; reference (see <a href="#renderMultiMedia">&lt;renderMultiMedia&gt;
                                          			(&sect;
                                          			4.3.5.6 )</a>). All values of attributes of type XML ID must be unique within the document (per the <a href="http://www.w3.org/TR/2004/REC-xml-20040204/#id" target="_blank">W3C XML specification</a>).
                                    </p>
                                    <p>The distinction between ObservationMedia and ExternalObservation is that ObservationMedia entries are part of the attested
                                       content of the document whereas ExternalObservations are not. For instance, when a clinician draws a picture as part of a
                                       progress note, that picture is represented as a CDA ObservationMedia. If that clinician is also describing a finding seen
                                       on a chest-x-ray, the referenced chest-x-ray is represented as a CDA ExternalObservation. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			99: Value set for ObservationMedia.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OBS (observation) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A multimedia observation.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			100: Value set for ObservationMedia.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Organizer"></a>4.3.6.5 </span><span class="title">Organizer</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM Act class, which can be used to create arbitrary groupings of other CDA entries that share a common
                                       context. An Organizer can contain other Organizers and/or other CDA entries, by traversing the component relationship. An
                                       Organizer can refer to external acts by traversing the reference relationship. An Organizer cannot be the source of an entryRelationship
                                       relationship. 
                                    </p>
                                    <blockquote><b>NOTE: </b>CDA entries such as Observation can also contain other CDA entries by traversing the entryRelationship class. There is no
                                       requirement that the Organizer entry be used in order to group CDA entries. 
                                    </blockquote>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			101: Value set for Organizer.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p> BATTERY (battery)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A battery specifies a set of observations.
                                                
                                                These observations typically have a logical or practical grouping for
                                                
                                                
                                                generally accepted clinical or functional purposes, such as observations
                                                
                                                that are grouped together because of automation.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>CLUSTER (cluster)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A group of entries that have a logical association
                                                
                                                with one another. The Cluster class permits aggregation into a compound
                                                
                                                
                                                
                                                statement.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			102: Value set for Organizer.moodCode (CNE)
                                       </caption>
                                       <tbody>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                          <tr>
                                             <td colspan="1">
                                                <p>EVN (event)</p>
                                             </td>
                                             <td colspan="1">
                                                <p>The entry defines an actual occurrence of an event</p>
                                             </td>
                                          </tr>
                                       </tbody>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Procedure"></a>4.3.6.6 </span><span class="title">Procedure</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM Procedure class, used for representing procedures. </p>
                                    <p>Procedure.negationInd, when set to "true", is a positive assertion that the Procedure as a whole is negated. Some properties
                                       such as Procedure.id, Procedure.moodCode, and the participations are not affected. These properties always have the same meaning:
                                       i.e., the author remains the author of the negative Procedure. A procedure statement with negationInd is still a statement
                                       about the specific fact described by the Procedure. For instance, a negated "appendectomy performed" means that the author
                                       positively denies that there was ever an appendectomy performed, and that he takes the same responsibility for such statement
                                       and the same requirement to have evidence for such statement than if he had not used negation. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			103: Value set for Procedure.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PROC (procedure) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An act whose immediate and primary outcome
                                                
                                                (post-condition) is the alteration of the physical condition of the subject.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			104: Value set for Procedure.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>INT (intent)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is intended or planned.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>APT (appointment)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is planned for a specific time and place.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>ARQ (appointment request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is a request for the booking of an appointment.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRMS (promise)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A commitment to perform the stated entry.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRP (proposal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A proposal that the stated entry be performed.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RQO (request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A request or order to perform the stated entry. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>DEF (definition)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines a service (master).</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="RegionOfInterest"></a>4.3.6.7 </span><span class="title">RegionOfInterest</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM Observation class that represents a region of interest on an image, using an overlay shape. RegionOfInterest
                                       is used to make reference to specific regions in images, e.g., to specify the site of a physical finding by "circling" a region
                                       in a schematic picture of a human body. The units of the coordinate values in RegionOfInterest.value are in pixels, expressed
                                       as a list of integers. The origin is in the upper left hand corner, with positive X values going to the right and positive
                                       Y values going down. The relationship between a RegionOfInterest and its referenced ObservationMedia or ExternalObservation
                                       is specified by traversing the entryRelationship or reference class, respectively, where typeCode equals "SUBJ". A RegionOfInterest
                                       must reference exactly one ObservationMedia or one ExternalObservation. If the RegionOfInterest is the target of a &lt;renderMultimedia&gt;
                                       reference, then it shall only reference an ObservationMedia and not an ExternalObservation.  
                                    </p>
                                    <p>An XML attribute "ID" of type XML ID, is added to RegionOfInterest within the CDA Schema. This attribute serves as the target
                                       of a &lt;renderMultiMedia&gt; reference (see <a href="#renderMultiMedia">&lt;renderMultiMedia&gt;
                                          			(&sect;
                                          			4.3.5.6 )</a>). All values of attributes of type XML ID must be unique within the document (per the <a href="http://www.w3.org/TR/2004/REC-xml-20040204/#id" target="_blank">W3C XML specification</a>).
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			105: Value set for RegionOfInterest.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ROIOVL (overlay region of interest) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A Region of Interest specified for an image using an overlay shape. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			106: Value set for RegionOfInterest.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			107: Value set for RegionOfInterest.code (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>CIRCLE (circle)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A circle defined by two (column,row) pairs.
                                                
                                                The first point is the center of the circle and the second point is a
                                                
                                                point on the perimeter of the circle.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>ELLIPSE (ellipse)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>An ellipse defined by four (column,row) pairs,
                                                
                                                the first two points specifying the endpoints of the major axis and the
                                                
                                                
                                                second two points specifying the endpoints of the minor axis.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>POINT (point)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A single point denoted by a single (column,row)
                                                
                                                
                                                
                                                
                                                pair, or multiple points each denoted by a (column,row) pair.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>POLY (polyline)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A series of connected line segments with
                                                
                                                ordered vertices denoted by (column,row) pairs; if the first and last
                                                
                                                vertices are the same, it is a closed polygon.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>The following example illustrates one sample use of RegionOfInterest. In this case, the clinician has identified a rash upon
                                       physical examination of the skin, and indicates this by creating a region of interest atop a hand image taken from an image
                                       library. The narrative block references the RegionOfInterest via the &lt;renderMultiMedia&gt; tag, and the referenced RegionOfInterest
                                       references the hand image.
                                       
                                       
                                    </p>
                                    <table width="90%">
                                       <caption>Example 9. Sample use of RegionOfInterest</caption>
                                       <tr>
                                          <td class="example"><pre><pre>
&lt;section&gt;
   &lt;code code="8709-8" codeSystem="2.16.840.1.113883.6.1" 
    codeSystemName="LOINC"/&gt;
   &lt;title&gt;Skin Exam&lt;/title&gt;
   &lt;text&gt;Erythematous rash, palmar surface, left index 
    finger.&lt;renderMultiMedia referencedObject="MM2"/&gt;
   &lt;/text&gt;
   &lt;entry&gt;
      &lt;observation classCode="OBS" moodCode="EVN"&gt;
         &lt;code code="271807003" 
          codeSystem="2.16.840.1.113883.6.96" 
          codeSystemName="SNOMED CT" 
          displayName="Rash"/&gt;
         &lt;statusCode code="completed"/&gt;
         &lt;targetSiteCode code="48856004" 
          codeSystem="2.16.840.1.113883.6.96" 
          codeSystemName="SNOMED CT" 
          displayName="Skin of palmer surface of index finger"&gt;
            &lt;qualifier&gt;
               &lt;name code="78615007" 
                codeSystem="2.16.840.1.113883.6.96" 
                displayName="with laterality"/&gt;
               &lt;value code="7771000" 
                codeSystem="2.16.840.1.113883.6.96" 
                displayName="left"/&gt;
            &lt;/qualifier&gt;
         &lt;/targetSiteCode&gt;
         &lt;entryRelationship typeCode="SPRT"&gt;
            &lt;regionOfInterest classCode="ROIOVL" moodCode="EVN" ID="MM2"&gt;
               &lt;id root="2.16.840.1.113883.19.3.1"/&gt;
               &lt;code code="ELLIPSE"/&gt;
               &lt;value value="3"/&gt;
               &lt;value value="1"/&gt;
               &lt;value value="3"/&gt;
               &lt;value value="7"/&gt;
               &lt;value value="2"/&gt;
               &lt;value value="4"/&gt;
               &lt;value value="4"/&gt;
               &lt;value value="4"/&gt;
               &lt;entryRelationship typeCode="SUBJ"&gt;
                  &lt;observationMedia classCode="OBS" moodCode="EVN"&gt;
                     &lt;id root="2.16.840.1.113883.19.2.1"/&gt;
                     &lt;value mediaType="image/jpeg"&gt;
                        &lt;reference value="lefthand.jpeg"/&gt;
                     &lt;/value&gt;
                  &lt;/observationMedia&gt;
               &lt;/entryRelationship&gt;
            &lt;/regionOfInterest&gt;
         &lt;/entryRelationship&gt;
      &lt;/observation&gt;
   &lt;/entry&gt;
&lt;/section&gt;
</pre></pre></td>
                                       </tr>
                                    </table>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="SubstanceAdministration"></a>4.3.6.8 </span><span class="title">SubstanceAdministration</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM SubstanceAdministration class, used for representing medication-related events such as medication
                                       history or planned medication administration orders.  
                                    </p>
                                    <p>SubstanceAdministration.negationInd, when set to "true", is a positive assertion that the SubstanceAdministration as a whole
                                       is negated. Some properties such as SubstanceAdministration.id, SubstanceAdministration.moodCode, and the participations are
                                       not affected. These properties always have the same meaning: i.e., the author remains the author of the negative SubstanceAdministration.
                                       A substance administration statement with negationInd is still a statement about the specific fact described by the SubstanceAdministration.
                                       For instance, a negated "aspirin administration" means that the author positively denies that aspirin is being administered,
                                       and that he takes the same responsibility for such statement and the same requirement to have evidence for such statement
                                       than if he had not used negation. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			108: Value set for SubstanceAdministration.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>SBADM (substance administration) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The act of introducing or otherwise applying a substance to the subject.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			109: Value set for SubstanceAdministration.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>INT (intent)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is intended or planned.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRMS (promise)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A commitment to perform the stated entry.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRP (proposal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A proposal that the stated entry be performed.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RQO (request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A request or order to perform the stated entry. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>SubstanceAdministration.priorityCode categorizes the priority of a substance administration. SubstanceAdministration.doseQuantity
                                       indicates how much medication is given per dose. SubstanceAdministration.rateQuantity can be used to indicate the rate at
                                       which the dose is to be administered (e.g., the flow rate for intravenous infusions). SubstanceAdministration.maxDoseQuantity
                                       is used to capture the maximum dose of the medication that can be given over a stated time interval (e.g., maximum daily dose
                                       of morphine, maximum lifetime dose of doxorubicin).
                                       
                                       SubstanceAdministration.effectiveTime is used to describe the timing of administration. It is modeled using the GTS data type
                                       to accommodate various dosing scenarios, as illustrated in the following example.
                                    </p>
                                    <table width="90%">
                                       <caption>Example 10. Sample representation of "take captopril 25mg PO every 12 hours, starting on Jan 01, 2002, ending on Feb 01, 2002"</caption>
                                       <tr>
                                          <td class="example"><pre><pre>
&lt;section&gt;
   &lt;text&gt;Take captopril 25mg PO every 12 hours, starting on 
    Jan 01, 2002, ending on Feb 01, 2002.
   &lt;/text&gt;
   &lt;entry&gt;
      &lt;substanceAdministration classCode="SBADM" moodCode="RQO"&gt;
         &lt;effectiveTime xsi:type="IVL_TS"&gt;
            &lt;low value="20020101"/&gt;
            &lt;high value="20020201"/&gt;
         &lt;/effectiveTime&gt;
         &lt;effectiveTime xsi:type="PIVL_TS" operator="A"&gt;
            &lt;period value="12" unit="h"/&gt;
         &lt;/effectiveTime&gt;
         &lt;routeCode code="PO" 
          codeSystem="2.16.840.1.113883.5.112" 
          codeSystemName="RouteOfAdministration"/&gt;
         &lt;doseQuantity value="1"/&gt;
         &lt;consumable&gt;
            &lt;manufacturedProduct&gt;
               &lt;manufacturedLabeledDrug&gt;
                  &lt;code code="318821008" 
                   codeSystem="2.16.840.1.113883.6.96" 
                   codeSystemName="SNOMED CT" 
                   displayName="Captopril 25mg tablet"/&gt;
               &lt;/manufacturedLabeledDrug&gt;
            &lt;/manufacturedProduct&gt;
         &lt;/consumable&gt;
      &lt;/substanceAdministration&gt;
   &lt;/entry&gt;
&lt;/section&gt;
</pre></pre></td>
                                       </tr>
                                    </table>
                                    <p>The capture of medication-related information also involves the interrelationship of SubstanceAdministration with several
                                       other classes. The consumable participation is used to bring in the LabeledDrug or Material entity that describes the administered
                                       substance. The LabeledDrug class, which is an Entity class playing the Role of Manufactured Product, identifies the drug that
                                       is consumed in the substance administration. The medication is identified by means of the LabeledDrug.code or the LabeledDrug.name.
                                       The Material entity is used to identify non-drug administered substances such as vaccines and blood products.
                                       
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			110: Value set for consumable.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>CSM (consumable) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A substance that is taken up or consumed as part of the substance administration. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			111: Value set for ManufacturedProduct.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>MANU (manufactured) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A manufactured product</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			112: Value set for LabeledDrug.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>MMAT (manufactured) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A manufactured material.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			113: Value set for LabeledDrug.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>KIND (kind) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The described determiner is used to indicate
                                                
                                                that the given Entity is taken as a general description of a kind of
                                                
                                                
                                                
                                                
                                                thing that can be taken in whole, in part, or in multiples.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			114: Value set for Material.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>MMAT (manufactured) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A manufactured material.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			115: Value set for Material.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>KIND (kind) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The described determiner is used to indicate
                                                
                                                that the given Entity is taken as a general description of a kind of
                                                
                                                
                                                
                                                
                                                thing that can be taken in whole, in part, or in multiples.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Supply"></a>4.3.6.9 </span><span class="title">Supply</span></div>
                                 <div class="body">
                                    <p>A derivative of the RIM Supply class, used for representing the provision of a material by one entity to another. </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			116: Value set for Supply.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>SPLY (supply) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The act of dispensing or delivering a product.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			117: Value set for Supply.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry defines an actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>INT (intent)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>The entry is intended or planned.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRMS (promise)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A commitment to perform the stated entry.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRP (proposal)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A proposal that the stated entry be performed.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RQO (request)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>A request or order to perform the stated entry. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>The dispensed product is associated with the Supply act via a product participant, which connects to the same ManufacturedProduct
                                       role used for SubstanceAdministration.
                                       
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			118: Value set for product.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRD (product) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A material target that is brought forth (e.g.
                                                
                                                
                                                dispensed) in the service.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>The Supply class represents dispensing, whereas the SubstanceAdministration class represents administration. Prescriptions
                                       are complex activities that involve both an administration request to the patient (e.g. take digoxin 0.125mg by mouth once
                                       per day) and a supply request to the pharmacy (e.g. dispense 30 tablets, with 5 refills). This should be represented in CDA
                                       by a SubstanceAdministration entry that has a component Supply entry. The nested Supply entry can have Supply.independentInd
                                       set to "false" to signal that the Supply cannot stand alone, without it's containing SubstanceAdministration. The following
                                       example illustrates a prescription representation in CDA.
                                    </p>
                                    <table width="90%">
                                       <caption>Example 11. Sample prescription representation in CDA "Digoxin 0.125mg, 1 PO qDay, #30, 5 refills"</caption>
                                       <tr>
                                          <td class="example"><pre><pre>
&lt;section&gt;
   &lt;text&gt;Digoxin 0.125mg, 1 PO qDay, #30, 5 refills.&lt;/text&gt;
   &lt;entry&gt;
      &lt;substanceAdministration classCode="SBADM" moodCode="RQO"&gt;
         &lt;effectiveTime xsi:type="PIVL_TS"&gt;
            &lt;period value="24" unit="h"/&gt;
         &lt;/effectiveTime&gt;
         &lt;routeCode code="PO" 
          codeSystem="2.16.840.1.113883.5.112" 
          codeSystemName="RouteOfAdministration"/&gt;
         &lt;doseQuantity value="1"/&gt;
         &lt;consumable&gt;
            &lt;manufacturedProduct&gt;
               &lt;manufacturedLabeledDrug&gt;
                  &lt;code code="317896006" 
                   codeSystem="2.16.840.1.113883.6.96" 
                   codeSystemName="SNOMED CT" 
                   displayName="Digoxin 125micrograms tablet"/&gt;
               &lt;/manufacturedLabeledDrug&gt;
            &lt;/manufacturedProduct&gt;
         &lt;/consumable&gt;
         &lt;entryRelationship typeCode="COMP"&gt;
            &lt;supply classCode="SPLY" moodCode="RQO"&gt;
               &lt;repeatNumber&gt;
                  &lt;low value="0"/&gt;
                  &lt;high value="5"/&gt;
               &lt;/repeatNumber&gt;
               &lt;independentInd value="false"/&gt;
               &lt;quantity value="30"/&gt;
            &lt;/supply&gt;
         &lt;/entryRelationship&gt;
      &lt;/substanceAdministration&gt;
   &lt;/entry&gt;
&lt;/section&gt;
</pre></pre></td>
                                       </tr>
                                    </table>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Entry_Participants"></a>4.3.7 </span><span class="title">Entry Participants</span></div>
                           <div class="body">
                              <p>CDA structures and entries can have various participants, some of which are also defined in the CDA header. As described in
                                 the discussion of CDA context (see <a href="#CDAContext">CDA Context
                                    			(&sect;
                                    			4.4 )</a>), participants propagated from the header can be overridden within the body. 
                                 
                                 
                                 
                                 
                                 
                              </p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_author"></a>4.3.7.1 </span><span class="title">author</span></div>
                                 <div class="body">
                                    <p>The author participant (described above, see <a href="#author">author
                                          			(&sect;
                                          			4.2.2.2 )</a>), can be ascribed to a CDA section where it overrides the value(s) propagated from the CDA header, or can be ascribed to
                                       a CDA entry, where it overrides the value(s) propagated from a CDA section and propagates to nested entries.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_consumable"></a>4.3.7.2 </span><span class="title">consumable</span></div>
                                 <div class="body">
                                    <p>The consumable participant is described above (see <a href="#CDA_Entry_Acts">Entry Acts
                                          			(&sect;
                                          			4.3.6 )</a>).
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_informant"></a>4.3.7.3 </span><span class="title">informant</span></div>
                                 <div class="body">
                                    <p>The informant participant (described above, see <a href="#informant">informant
                                          			(&sect;
                                          			4.2.2.6 )</a>), can be ascribed to a CDA section where it overrides the value(s) propagated from the CDA header, or can be ascribed to
                                       a CDA entry, where it overrides the value(s) propagated from a CDA section and propagates to nested entries. 
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_participant"></a>4.3.7.4 </span><span class="title">participant</span></div>
                                 <div class="body">
                                    <p>Can be used to represent any other participant that cannot be represented with one of the more specific participants. The
                                       participant can be ascribed to a CDA entry, and propagates to nested CDA entries, unless overridden.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			119: Value set for participant.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ParticipationType subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ParticipationType" for allowable values.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			120: Value set for participant.contextControlCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OP (overriding propagating) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The participant overrides associations with
                                                
                                                the same typeCode. This overriding association will
                                                
                                                
                                                propagate to any descendant Acts reached by conducting ActRelationships.
                                                
                                                
                                                (See section "CDA Context" below.)
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>A participant is an entity playing one of several possible roles (ParticipantRole class). The entity playing the role is a
                                       device (Device class) or other entity (PlayingEntity class). The scoper is any entity (Entity class).
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			121: Value set for ParticipantRole.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ROL (RoleClassRoot) subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "RoleClassRoot" for allowable values.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			122: Value set for Device.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>DEV (device) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An entity used in an activity, without being
                                                
                                                substantially changed through that activity. 
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any DEV subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "EntityClassDevice" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			123: Value set for Device.determinerCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (instance) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			124: Value set for PlayingEntity.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ENT (entity) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A physical thing, group of physical things
                                                
                                                or an organization capable of participating in Acts, while in a role.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ENT subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "EntityClassRoot" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			125: Value set for PlayingEntity.determinerCode
                                          
                                          (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (instance) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			126: Value set for Entity.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ENT (entity) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A physical thing, group of physical things
                                                
                                                or an organization capable of participating in Acts, while in a role.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ENT subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "EntityClassRoot" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			127: Value set for Entity.determinerCode
                                          
                                          (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>INSTANCE (instance) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The INSTANCE determiner indicates an actual occurrence of an entity, as opposed to the KIND determiner, which refers to the
                                                general description of a kind of entity. For example, one can refer to a specific car (a car instance), or one can refer to
                                                cars in general (a car kind).
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_performer"></a>4.3.7.5 </span><span class="title">performer</span></div>
                                 <div class="body">
                                    <p>The performer is a person who carries out or will carry out a particular act. The performer need not be the principal responsible
                                       participant, e.g. a surgery resident operating under supervision of attending surgeon is a performer.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			128: Value set for performer.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRF (performer) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A person who actually and principally carries
                                                
                                                out or will carry out the action. The traditional order filler is a performer. 
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_product"></a>4.3.7.6 </span><span class="title">product</span></div>
                                 <div class="body">
                                    <p>The product participant is described above (see <a href="#CDA_Entry_Acts">Entry Acts
                                          			(&sect;
                                          			4.3.6 )</a>).
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_specimen"></a>4.3.7.7 </span><span class="title">specimen</span></div>
                                 <div class="body">
                                    <p>A specimen is a part of some entity, typically the subject, that is the target of focused laboratory, radiology or other observations.
                                       In many clinical observations, such as physical examination of a patient, the patient is the subject of the observation, and
                                       there is no specimen. The specimen participant is only used when observations are made against some substance or object that
                                       is taken or derived from the subject.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			129: Value set for specimen.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>SPC (specimen) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The subject of non-clinical (e.g. laboratory) observation services.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			130: Value set for SpecimenRole.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>SPEC (specimen) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A role played by a material entity that is a specimen for an act.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entry_subject"></a>4.3.7.8 </span><span class="title">subject</span></div>
                                 <div class="body">
                                    <p>The subject participant (described above, see <a href="#section_subject">subject
                                          			(&sect;
                                          			4.3.3.3 )</a>), can be ascribed to a CDA section, or it can be ascribed to a CDA entry, where it overrides the value(s) propagated from
                                       a CDA section and propagates to nested entries. 
                                    </p>
                                 </div>
                              </div>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Entry_Relationships"></a>4.3.8 </span><span class="title">Entry Relationships</span></div>
                           <div class="body">
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="component2"></a>4.3.8.1 </span><span class="title">component</span></div>
                                 <div class="body">
                                    <p>The component relationship has a source of Organizer (see <a href="#Organizer">Organizer
                                          			(&sect;
                                          			4.3.6.5 )</a>, and a target that is another CDA entry, and is used to create groupings of CDA entries within an Organizer.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			131: Value set for component.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>COMP (component) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The associated CDA entry is a component of the organizer.</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="precondition"></a>4.3.8.2 </span><span class="title">precondition</span></div>
                                 <div class="body">
                                    <p>The precondition class, derived from the ActRelationship class, is used along with the Criterion class to express a condition
                                       that must hold true before some over activity occurs.  
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			132: Value set for precondition.typeCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PRCN (precondition) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A requirement to be true before a service is performed. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			133: Value set for Criterion.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>OBS (observation) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Observations are actions performed in order to determine an answer or result value. </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any OBS subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassObservation" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			134: Value set for Criterion.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN.CRT (event criterion) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A criterion or condition that must apply
                                                
                                                for an associated service to be considered.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="referenceRange"></a>4.3.8.3 </span><span class="title">referenceRange</span></div>
                                 <div class="body">
                                    <p>The referenceRange relationship (described above, see <a href="#Observation">Observation
                                          			(&sect;
                                          			4.3.6.3 )</a>), has a source of Observation, and a target of ObservationRange.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="entryRelationship"></a>4.3.8.4 </span><span class="title">entryRelationship</span></div>
                                 <div class="body">
                                    <p>CDA has identified and modeled various link and reference scenarios. These scenarios enable CDA entries to be semantically
                                       linked to entries that exist within the same document (by traversing the entryRelationship class) or to objects external to
                                       it (by traversing the reference class). 
                                    </p>
                                    <blockquote><b>NOTE: </b>The CDA specification permits any CDA entry to relate to any CDA entry using any of the following relationship types. In many
                                       cases, this would result in nonsensical relationships. The following table is a guideline for reasonable relationships between
                                       CDA entries, and is not a conformance constraint. 
                                       
                                       
                                    </blockquote>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			135: CDA entryRelationship Types
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">ActRelationship Type</th>
                                             <th colspan="1">Reasonable Source and Target entries </th>
                                             <th colspan="1">Comments</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>CAUS (is etiology for)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Observation | Procedure | SubstanceAdministration] <br><strong>CAUS</strong><br>
                                                
                                                [Observation]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show that the source caused the target
                                                
                                                observation (for instance, source "diabetes mellitus" is the
                                                
                                                cause of target "kidney disease").
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>COMP (has component)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Observation | Procedure | SubstanceAdministration
                                                
                                                | Supply] <br><strong>COMP</strong><br>
                                                
                                                [Act | Observation | Procedure | SubstanceAdministration | Suppply]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show that the target is a component
                                                
                                                of the source (for instance "hemoglobin measurement" is a component
                                                
                                                of a "complete blood count").
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>GEVL (evaluates (goal))</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Observation] <br><strong>GEVL</strong><br> [Observation]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to link an observation (intent or actual)
                                                
                                                to a goal to indicate that the observation evaluates the goal (for instance,
                                                
                                                a source observation of "walking distance" evaluates a target
                                                
                                                goal of "adequate walking distance").
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>MFST (is manifestation of)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Observation] <br><strong>MFST</strong><br>
                                                
                                                [Observation]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to say that the source is a manifestation
                                                
                                                of the target (for instance, source "hives" is a manifestation
                                                
                                                
                                                
                                                
                                                of target "penicillin allergy").
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>REFR (refers to)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Observation | Procedure | SubstanceAdministration
                                                
                                                
                                                
                                                | Supply] <br><strong>REFR</strong><br>
                                                
                                                [Act | Observation | ObservationMedia | Procedure | RegionOfInterest
                                                
                                                | SubstanceAdministration | Supply]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show a general relationship between
                                                
                                                the source and the target, when the more specific semantics of the relationship
                                                
                                                isn't known.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RSON (has reason)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Encounter | Observation | Procedure
                                                
                                                | SubstanceAdministration | Supply] <br><strong>RSON</strong><br>
                                                
                                                [Act | Encounter | Observation | Procedure | SubstanceAdministration
                                                
                                                | Supply]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show the reason or rational for a
                                                
                                                service (for instance source "treadmill test" has reason "chest
                                                
                                                pain").
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>SAS (starts after start)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Encounter | Observation | Procedure
                                                
                                                | SubstanceAdministration | Supply] <br><strong>SAS</strong><br>
                                                
                                                
                                                [Act | Encounter | Observation | Procedure | SubstanceAdministration
                                                
                                                
                                                
                                                | Supply]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The source Act starts after the start of
                                                
                                                
                                                the target Act (for instance source "diaphoresis" starts after
                                                
                                                the start of target "chest pain").
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>SPRT (has support)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Observation] <br><strong>SPRT</strong><br>
                                                
                                                [Observation | ObservationMedia | RegionOfInterest]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show that the target provides supporting evidence for the source (for instance source "possible lung tumor" has support
                                                target "mass seen on chest-x-ray").
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>SUBJ (has subject)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Observation | RegionOfInterest] <br><strong>SUBJ</strong><br>
                                                
                                                [Observation | ObservationMedia]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to relate a source region of interest
                                                
                                                to a target image, or to relate an observation to its subject observation
                                                
                                                (for instance, source "moderate severity" has subject target "chest
                                                
                                                pain"). 
                                             </p>
                                             <p>The ActRelationshipType "has subject" is similar to the
                                                
                                                ParticipationType "subject". Entries that primarily operate
                                                
                                                on physical subjects use the Participation, whereas entries that primarily
                                                
                                                operate on other entries use the ActRelationship.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>XCRPT (is excerpt of)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Observation] <br><strong>XCRPT</strong><br>
                                                
                                                [Act | Observation | Procedure | SubstanceAdministration | Supply]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show that the source is excerpted
                                                
                                                
                                                
                                                
                                                from the target (for instance source "hemoglobin value of 12" is
                                                
                                                an excerpt of target "complete blood count").
                                             </p>
                                             <p>The distinction between an excerpt and an informant participant can
                                                
                                                
                                                
                                                be blurry &#8212; such as in the case of recording a patient's medication
                                                
                                                history where the clinician may obtain the information from an informant
                                                
                                                or may excerpt the information from another computer system. An informant
                                                
                                                
                                                (or source of information) is a person who provides relevant information.
                                                
                                                
                                                
                                                An informant class is in the header, and can be overridden in the body.
                                                
                                                An excerpt is a sub portion of some other act.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>The entryRelationship.inversionInd can be set to "true" to indicate that the relationship should be interpreted as if the
                                       roles of the source and target entries were reversed. In the example in the table above, "treadmill test" RSON (has reason)
                                       "chest pain". Inverted, this would have "chest pain" as the source and "treadmill test" as the target: "chest pain" RSON (inverted)
                                       "treadmill test". Inversion can be useful when the current context is describing the target of an act relationship that needs
                                       to be related back to the source.
                                    </p>
                                    <p>
                                       
                                       The entryRelationship.contextConductionInd differs from the otherwise common use of this attribute (see <a href="#CDAContext">CDA Context
                                          			(&sect;
                                          			4.4 )</a>) in that in all other cases where this attribute is used, the value is fixed at "true", whereas here the value is defaulted
                                       to "true", and can be changed to "false" when referencing an entry in the same document. Setting the context conduction to
                                       false when referencing an entry in the same document keeps clear the fact that the referenced object retains its original
                                       context.
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="reference"></a>4.3.8.5 </span><span class="title">reference</span></div>
                                 <div class="body">
                                    <p>CDA entries can reference external objects such as external images and prior reports. These external objects are not part
                                       of the authenticated document content. They contain sufficient attributes to enable an explicit reference rather than duplicating
                                       the entire referenced object. The CDA entry that wraps the external reference can be used to encode the specific portions
                                       of the external reference that are addressed in the narrative block.
                                    </p>
                                    <p>Each object allows for an identifier and a code, and contains the RIM Act.text attribute, which can be used to store the URL
                                       and MIME type of the object. External objects always have a fixed moodCode of "EVN". 
                                    </p>
                                    <p>The reference class contains the attribute reference.seperatableInd, which indicates whether or not the source is intended
                                       to be interpreted independently of the target. The indicator cannot prevent an individual or application from separating the
                                       source and target, but indicates the author's desire and willingness to attest to the content of the source if separated from
                                       the target. Typically, where seperatableInd is "false", the exchanged package should include the target of the reference so
                                       that the recipient can render it. 
                                    </p>
                                    <p>A description of allowable reference.typeCode values are shown in the following table. As in the table above (CDA entryRelationship
                                       Types), the following table is a guideline for reasonable relationships between CDA entries and external objects, and is not
                                       a conformance constraint.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			136: CDA reference Types
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">ActRelationship Type</th>
                                             <th colspan="1">Reasonable Source and Target classes </th>
                                             <th colspan="1">Comments</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ELNK (episode link)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Observation] <br><strong>ELNK</strong><br> [ExternalObservation]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show that the source and the target
                                                
                                                are part of the same episode (for instance, a diagnosis of "pneumonia" can
                                                
                                                be linked to an external problem list entry of "pneumonia" to
                                                
                                                
                                                show that the current diagnosis is part of the ongoing episode of pneumonia).
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>REFR (refers to)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Observation | Procedure | SubstanceAdministration
                                                
                                                | Supply] <br><strong>REFR</strong><br>
                                                
                                                [ExternalAct | ExternalDocument | ExternalObservation | ExternalProcedure]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show a general relationship between
                                                
                                                
                                                
                                                the source and the target, when the more specific semantics of the relationship
                                                
                                                isn't known.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>RPLC (replace)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Encounter | Observation | ObservationMedia | Organizer | Procedure | SubstanceAdministration
                                                
                                                | Supply] <br><strong>RPLC</strong><br>
                                                
                                                [ExternalAct | ExternalDocument | ExternalObservation | ExternalProcedure]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to indicate that the source entry is a replacement for the target external act.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>SPRT (has support)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Observation] <br><strong>SPRT</strong><br>
                                                
                                                [ExternalDocument | ExternalObservation]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show that the target provides supporting
                                                
                                                evidence for the source.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p> SUBJ (has subject) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Observation | RegionOfInterest] <br><strong>SUBJ</strong><br>
                                                
                                                [ExternalObservation]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to relate a source region of interest
                                                
                                                to a target image, or to relate an observation to its subject observation.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p> XCRPT (is excerpt of) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>[Act | Observation] <br><strong>XCRPT</strong><br>
                                                
                                                [ExternalAct | ExternalDocument | ExternalObservation | ExternalProcedure]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>Used to show that the source is excerpted
                                                
                                                
                                                from the target (for instance "the hemoglobin is 10.7" is an
                                                
                                                excerpt of an externally referenced "complete blood count").
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>Target classes of the reference relationship include ExternalAct, ExternalDocument, ExternalObservation, and External Procedure.
                                       
                                    </p>
                                    <p>ExternalAct is a derivative of the RIM Act class, to be used when the other more specific classes are not appropriate. </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			137: Value set for ExternalAct.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>ACT (act) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>A healthcare service.</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any ACT subtype.</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassRoot" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			138: Value set for ExternalAct.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>ExternalDocument is a derivative of the RIM Document class, used for representing external documents.  ExternalDocument.text
                                       is modeled as an ED data type - allowing for the expression of the MIME type of the external document. 
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			139: Value set for ExternalDocument.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>DOC (document) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>The notion of a document comes particularly
                                                
                                                
                                                
                                                from the paper world, where it corresponds to the contents recorded on
                                                
                                                discrete pieces of paper. In the electronic world, a document is a kind
                                                
                                                of composition that bears resemblance to their paper world counter-parts.
                                                
                                                Documents typically are meant to be human-readable. HL7's notion of document
                                                
                                                differs from that described in the W3C XML Recommendation, in which a
                                                
                                                document refers specifically to the contents that fall between the root
                                                
                                                
                                                
                                                element's start-tag and end-tag. Not all XML documents are HL7 documents.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>Any DOC subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassDocument" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			140: Value set for ExternalDocument.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>ExternalObservation is a derivative of the RIM Observation class, used for representing external coded and other observations.
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			141: Value set for ExternalObservation.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p> OBS (observation) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p> Observations are actions performed in order
                                                
                                                
                                                to determine an answer or result value.
                                             </p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p> Any OBS subtype</p>
                                          </td>
                                          <td colspan="1">
                                             <p>See vocabulary domain "ActClassObservation" for allowable values. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			142: Value set for ExternalObservation.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p> EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p> An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <p>ExternalProcedure is a derivative of the RIM Procedure class, used for representing external procedures. 
                                       
                                       
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			143: Value set for ExternalProcedure.classCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>PROC (procedure) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An Act whose immediate and primary outcome
                                                
                                                
                                                
                                                (post-condition) is the alteration of the physical condition of the subject.
                                             </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			144: Value set for ExternalProcedure.moodCode (CNE)
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">Code</th>
                                             <th colspan="1">Definition</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>EVN (event) [<strong>default</strong>]
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>An actual occurrence of an event. </p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDAContext"></a>4.4 </span><span class="title">CDA Context</span></div>
                     <div class="body">
                        <p>CDA context is set in the CDA header and applies to the entire document. Context can be overridden at the level of the body,
                           section, and/or CDA entry.
                        </p>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Overview_of_CDA_Context"></a>4.4.1 </span><span class="title">Overview of CDA Context</span></div>
                           <div class="body">
                              <p>A document, in a sense, is a contextual wrapper for its contents. Assertions in the document header are typically applicable
                                 to statements made in the body of the document, unless overridden. For instance, the patient identified in the header is assumed
                                 to be the subject of observations described in the body of the document, unless a different subject is explicitly stated,
                                 or the author identified in the header is assumed to be the author of the entire document, unless a different author is explicitly
                                 identified on a section. The objective of the CDA context rules are to make these practices explicit with relationship to
                                 the RIM, such that a computer will understand the context of a portion of a document the same way that a human interprets
                                 it. 
                              </p>
                              <p>At the same time, there is no guarantee that machine processing will identify a mistaken application of contextual rules.
                                 If a physician records an "outside diagnosis" in narrative but does not nullify the "informant" context, machine processing
                                 will not identify the switch in attribution. This is a special case illustrating the limits of automated validation of electronic
                                 records and would apply regardless of the context inheritance mechanism. In other words, from some errors of encoding, there
                                 is no recovery other than human review.
                              </p>
                              <p>CDA's approach to context, and the propagation of that context to nested document components, follows these design principles:
                                 
                                 
                                 <ul style="margin-left:20px;">
                                    <li>CDA uses the RIM context mechanism (contextControlCode for Participations; contextConductionInd  for ActRelationships), and
                                       assigns fixed values to these attributes to accomplish the design objectives below, thus constraining the RIM context model.
                                       CDA extends the context propagation property to designated attributes of the CDA Header, which also propagate through any
                                       ActRelationship for which contextConductionInd="true".
                                    </li>
                                    <li>The CDA Header sets context for the entire document. A propagating value specified in the document header holds true throughout
                                       the document, unless explicitly overridden. This principal applies to both Participations and to designated attributes of
                                       the CDA Header. Contextual header components (i.e., those that have propagating values) include:
                                       
                                       
                                       <ul>
                                          <li>Author</li>
                                          <li>Confidentiality</li>
                                          <li>Data enterer</li>
                                          <li>Human language</li>
                                          <li>Informant</li>
                                          <li>Legal authenticator</li>
                                          <li>Participant</li>
                                          <li>Record target</li>
                                       </ul>
                                    </li>
                                    <li>Context components that can be overridden at the level of the document body include:
                                       
                                       
                                       
                                       
                                       <ul>
                                          <li>Confidentiality</li>
                                          <li>Human language</li>
                                       </ul>
                                    </li>
                                    <li>Context components that can be overridden at the level of a document section include:
                                       
                                       
                                       <ul>
                                          <li>Author</li>
                                          <li>Confidentiality</li>
                                          <li>Human language</li>
                                          <li>Informant</li>
                                          <li>Subject</li>
                                       </ul>
                                    </li>
                                    <li>Context components that can be overridden at the level of a CDA entry include:
                                       
                                       
                                       <ul>
                                          <li>Author</li>
                                          <li>Human language</li>
                                          <li>Informant</li>
                                          <li>Participant</li>
                                          <li>Subject</li>
                                       </ul>
                                    </li>
                                    <li>Context propagates from outer tags to nested tags. Context that is specified on an outer tag holds true for all nested tags,
                                       unless overridden on a nested tag. Context specified on a tag within the CDA body always overrides context propagated from
                                       an outer tag. For instance, the specification of authorship at a document section level overrides all authorship propagated
                                       from outer tags.
                                       
                                       
                                    </li>
                                    <li>Context is sometimes known precisely, and is sometimes unknown, such as in the case where a document is comprised of a large
                                       unparsed narrative block that potentially includes statements that contradict outer context. Because CDA context always propagates
                                       unless overridden, the representation of unknown context is achieved by overriding with a null value.
                                       
                                       
                                       
                                    </li>
                                 </ul>
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Technical_Aspects_of_CDA_Context"></a>4.4.2 </span><span class="title">Technical Aspects of CDA Context</span></div>
                           <div class="body">
                              <p>The RIM defines the "context" of an act as those participants of the act that can be propagated to nested acts. In the RIM,
                                 whether or not contextual participants do propagate to nested acts depends on whether or not the intervening act relationship
                                 between parent and child act allows for conduction of context. The explicit representation of context, and whether or not
                                 the context on an act can propagate to nested acts, is expressed via the RIM attributes Participation.contextControlCode and
                                 ActRelationship.contextConductionInd. CDA constrains the general RIM context mechanism such that context always overrides
                                 and propagates, as shown in the following table.
                              </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			145: CDA constraints on RIM context attributes
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">RIM attribute</th>
                                       <th colspan="1">Cardinality </th>
                                       <th colspan="1">Conformance</th>
                                       <th colspan="1">Fixed Value</th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>Participation.contextControlCode</p>
                                    </td>
                                    <td colspan="1">
                                       <p>1..1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>Mandatory (NULL values not permitted)</p>
                                    </td>
                                    <td colspan="1">
                                       <p>"OP" (overriding, propagating)</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>ActRelationship.contextConductionInd</p>
                                    </td>
                                    <td colspan="1">
                                       <p>1..1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>Mandatory (NULL values not permitted)</p>
                                    </td>
                                    <td colspan="1">
                                       <p>"true"*</p>
                                    </td>
                                 </tr>
                              </table>
                              <p>* The one exception to this is entryRelationship.contextConductionInd, which is defaulted to "true", but can be changed to
                                 "false". See <a href="#entryRelationship">entryRelationship
                                    			(&sect;
                                    			4.3.8.4 )</a> for details.
                              </p>
                              <p>Where the context of a nested component is unknown, the propagated context must be overridden with a null-valued component,
                                 as shown in the following table.
                              </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			146: Blocking context propagation with null values
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">Context</th>
                                       <th colspan="1">Null value representation </th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>Author</p>
                                    </td>
                                    <td colspan="1">
                                       <p>AssignedAuthor.id = NULL; No playing entity;
                                          
                                          
                                          
                                          
                                          No scoping entity.
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>Confidentiality</p>
                                    </td>
                                    <td colspan="1">
                                       <p>confidentialityCode = NULL.</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>Human language</p>
                                    </td>
                                    <td colspan="1">
                                       <p>languageCode = NULL.</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>Informant</p>
                                    </td>
                                    <td colspan="1">
                                       <p>AssignedEntity.id = NULL; No playing entity;
                                          
                                          No scoping entity.
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>Participant</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ParticipantRole.id = NULL; No playing entity;
                                          
                                          
                                          No scoping entity.
                                       </p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                              <p>The following exhibit illustrates the CDA context model. ClinicalDocument has an author participant, a confidentialityCode,
                                 and a languageCode, all of which will propagate to nested acts. The component act relationship going from ClinicalDocument
                                 to bodyChoice has contextConductionInd fixed as "true", thus allowing for the propagation of context. The bodyChoice classes,
                                 NonXMLBody and StructuredBody, contain a confidentialityCode and languageCode which can be used to override the value specified
                                 in the header. The component act relationship going from StructuredBody to Section has contextConductionInd fixed at "true",
                                 thus the context on StructuredBody will propagate through to Section. Section can override confidentialityCode, languageCode,
                                 and author. A null value for the Section's author participant indicates that the author for that particular section is unknown.
                              </p>
                              <table width="90%">
                                 <tr>
                                    <td class="figure"><pre><a href="graphics/L-ContextExample.gif" target="_blank" border="0">Link to wide graphic (opens in a new window)</a></pre></td>
                                 </tr>
                              </table>
                              <p>Because context is always overriding and propagating, one can compute the context of a given node by looking for the most
                                 proximate assertion. The following example is a sample XPath expression that can be used to identify the &lt;author&gt; context
                                 of a section or entry:
                                 
                                 
                              </p>
                              <table width="90%">
                                 <caption>Example 12. Sample XPath expression for the author of the current node</caption>
                                 <tr>
                                    <td class="example"><pre><pre>

(ancestor-or-self::*/author)[position()=last()]

</pre></pre></td>
                                 </tr>
                              </table>
                           </div>
                        </div>
                     </div>
                  </div>
               </div>
            </div>
            <div class="subSection">
               <!--divN/head-->
               <div class="header"><span class="icon"><img src="../../support/graphics/NormativeStandard.gif" alt="NormativeStandard"></span><span class="number"><a name="CDA_Hierarchical_Description"></a>5 </span><span class="title">CDA Hierarchical Description</span></div>
               <div class="body">
                  <blockquote><b>NOTE: </b>The definitive description of HL7 Hierarchical Description development and interpretation can be found <a href="../../help/v3guide/v3guide.htm#v3ghmd">here</a>.
                     
                     
                  </blockquote>
                  <p>The <a href="POCD_HD000040.xls" target="_blank">CDA Hierarchical Description POCD_HD000040 as an Excel View</a> can be found here.
                  </p>
                  <p>The CDA HD is the definitive source for CDA conformance rules, and serves as the source from which the CDA Schema is derived.
                     While a CDA instance must validate against the CDA Schema, it must also adhere to the conformance rules stated in the CDA
                     Hierarchical Description, and to the rules expressed in the narrative of this specification. 
                     
                     
                  </p>
                  <p>HL7 enables conformance specification at the level of each RIM attribute. RIM attributes can be defined as "Required", in
                     which case the originator must populate the attribute where a value is known even if the cardinality is optional, and "Mandatory",
                     in which case the originator must populate the attribute with a non-NULL value in all cases.
                  </p>
                  <p>In CDA, Release Two, the "Required" and "Mandatory" conformance indicators are applied as follows:
                     
                     
                  </p>
                  <ul style="margin-left:20px;">
                     <li>Required attributes:
                        
                        
                        
                        						
                        <ul>
                           <li>Section.text</li>
                           <li>All attributes where lower cardinality is greater than 0.</li>
                        </ul>
                     </li>
                     <li>Mandatory attributes:
                        
                        						
                        <ul>
                           <li>ClinicalDocument.typeId</li>
                           <li>RIM Structural Attributes
                              
                              								
                              <ul>
                                 <li>ClassCode</li>
                                 <li>MoodCode</li>
                                 <li>TypeCode</li>
                                 <li>DeterminerCode</li>
                              </ul>
                           </li>
                           <li>Context attributes
                              
                              								
                              <ul>
                                 <li>contextControlCode</li>
                                 <li>ContextConductionInd</li>
                              </ul>
                           </li>
                        </ul>
                     </li>
                  </ul>
                  <blockquote><b>NOTE: </b>Note that where Mandatory attributes have a default or fixed value supplied in the CDA HD, the instance need not contain a
                     value. In such cases, the receiver must assume the default value.
                     
                     
                  </blockquote>
               </div>
            </div>
            <div class="subSection">
               <!--divN/head-->
               <div class="header"><span class="icon"><img src="../../support/graphics/NormativeStandard.gif" alt="NormativeStandard"></span><span class="number"><a name="CDA_Schema"></a>6 </span><span class="title">CDA XML Implementation</span></div>
               <div class="body">
                  <blockquote><b>NOTE: </b>The definitive description of HL7 XML Implementation Technology Specification and the process used to go from Hierarchical
                     Description to Schema can be found <a href="../../infrastructure/itsxml/messaging-its-xml.htm#">here</a>.
                     
                     
                  </blockquote>
                  <p><a href="CDA.xsd" target="_blank">The CDA Schema can be found here</a></p>
                  <p><a href="../../processable/coreschemas/datatypes.xsd" target="_blank">The Datatypes.xsd file can be found here</a></p>
                  <p><a href="../../processable/coreschemas/datatypes-base.xsd" target="_blank">The Datatypes-base.xsd file can be found here</a></p>
                  <p><a href="POCD_MT000040.xsd" target="_blank">The POCD_MT000040.xsd file can be found here</a></p>
                  <p><a href="../../processable/coreschemas/NarrativeBlock.xsd" target="_blank">The CDA Narrative Block schema can be found here.</a></p>
                  <p><a href="../../processable/coreschemas/voc.xsd" target="_blank">The voc.xsd file can be found here.</a></p>
                  <p>The CDA Schema is not itself a normative artifact. Rather, checking an instance against the CDA Schema is a surrogate for
                     validating conformance against the normative XML ITS.
                  </p>
                  <p>The CDA Narrative Block, which is the XML content model of section.text, is manually crafted, as described above (see <a href="#CDA_Section_Narrative_Block">Section Narrative Block
                        			(&sect;
                        			4.3.5 )</a>). Note that while the CDA Schema is not a normative artifact, the CDA Narrative Block schema is.
                  </p>
               </div>
            </div>
            <div class="subSection">
               <!--divN/head-->
               <div class="header"><span class="icon"><img src="../../support/graphics/Reference.gif" alt="Reference"></span><span class="number"><a name="Appendices"></a>7 </span><span class="title">Appendices</span></div>
               <div class="body">
                  <p>The appendices contain non-normative material supplied as aids to understanding and implementing the technical specifications
                     described above.
                     
                     
                  </p>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Samples"></a>7.1 </span><span class="title">Samples</span></div>
                     <div class="body">
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Sample_Document"></a>7.1.1 </span><span class="title">Sample Document</span></div>
                           <div class="body">
                              <p>Good Health Clinic Consultation note</p>
                              <p>Consultant:	Robert Dolin, MD</p>
                              <p>Date:		April 7, 2000</p>
                              <p>Patient:		Henry Levin, the 7th;	MRN:	12345;	Sex: Male</p>
                              <p>Birthdate:	September 24, 1932</p>
                              <p><strong>History of Present Illness</strong></p>
                              <p>Henry Levin, the 7th is a 67 year old male referred for further asthma management. Onset of asthma in his teens. He was hospitalized
                                 twice last year, and already twice this year. He has not been able to be weaned off steroids for the past several months.
                                 
                              </p>
                              <p><strong>Past Medical History</strong></p>
                              <ul style="margin-left:20px;">
                                 <li>Asthma</li>
                                 <li>Hypertension (see HTN.cda for details) </li>
                                 <li>Osteoarthritis, right knee
                                    
                                    
                                    
                                    
                                    
                                 </li>
                              </ul>
                              <p><strong>Medications</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Theodur 200mg BID</li>
                                    <li>Albuterol inhaler 2puffs QID PRN</li>
                                    <li>Prednisone 20mg qd</li>
                                    <li>HCTZ 25mg qd</li>
                                 </ul>
                              </p>
                              <p><strong>Allergies and Adverse Reactions</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Penicillin - Hives</li>
                                    <li>Aspirin - Wheezing</li>
                                    <li>Codeine - Itching and nausea</li>
                                 </ul>
                              </p>
                              <p><strong>Family History</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Father had fatal MI in his early 50's.</li>
                                    <li>No cancer or diabetes.</li>
                                 </ul>
                              </p>
                              <p><strong>Social History</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Smoking :: 1 PPD between the ages of 20 and 55, and then he quit.</li>
                                    <li>Alcohol :: Rare</li>
                                 </ul>
                              </p>
                              <p><strong>Physical Exam</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Vital Signs</li>
                                 </ul>
                              </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <tbody>
                                    <tr>
                                       <th colspan="1">Date / Time</th>
                                       <th colspan="1">April 7, 2000 14:30</th>
                                       <th colspan="1">April 7, 2000 15:30</th>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Height</td>
                                       <td colspan="1">177 cm (69.7 in)</td>
                                       <td colspan="1"></td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Weight</td>
                                       <td colspan="1">194.0 lbs (88.0 kg)</td>
                                       <td colspan="1"></td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">BMI</td>
                                       <td colspan="1">28.1 kg/m2</td>
                                       <td colspan="1"></td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">BSA</td>
                                       <td colspan="1">2.05 m2</td>
                                       <td colspan="1"></td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Temperature</td>
                                       <td colspan="1">36.9 C (98.5 F)</td>
                                       <td colspan="1"></td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Pulse</td>
                                       <td colspan="1">86 / minute</td>
                                       <td colspan="1">84 / minute</td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Rhythm</td>
                                       <td colspan="1">Regular</td>
                                       <td colspan="1">Regular</td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Respirations</td>
                                       <td colspan="1">16 / minute, unlabored</td>
                                       <td colspan="1">14 / minute</td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Systolic</td>
                                       <td colspan="1">132 mmHg</td>
                                       <td colspan="1">135 mmHg</td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Diastolic</td>
                                       <td colspan="1">86 mmHg</td>
                                       <td colspan="1">88 mmHg</td>
                                    </tr>
                                    <tr>
                                       <td colspan="1">Position - Cuff</td>
                                       <td colspan="1">Left Arm</td>
                                       <td colspan="1">Left Arm</td>
                                    </tr>
                                 </tbody>
                              </table>
                              <p></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Skin :: Erythematous rash, palmar surface, left index finger.<br><img class="graphic" border="0" src="graphics/lefthand.gif" alt="lefthand.gif"><br><br></li>
                                    <li>Lungs :: Clear with no wheeze. Good air flow.</li>
                                    <li>Cardiac :: RRR with no murmur, no S3, no S4.</li>
                                 </ul>
                              </p>
                              <p><strong>Labs</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>CXR 02/03/1999: Hyperinflated. Normal cardiac silhouette, clear lungs.</li>
                                    <li>Peak Flow today: 260 l/m.</li>
                                 </ul>
                              </p>
                              <p><strong>In-office Procedure</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Suture removal, left forearm. </li>
                                 </ul>
                              </p>
                              <p><strong>Assessment</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Asthma, with prior smoking history. Difficulty weaning off steroids. Will try gradual taper.</li>
                                    <li>Hypertension, well-controlled.</li>
                                    <li>Contact dermatitis on finger.</li>
                                 </ul>
                              </p>
                              <p><strong>Plan</strong></p>
                              <p>
                                 <ul style="margin-left:20px;">
                                    <li>Complete PFTs with lung volumes.</li>
                                    <li>Chem-7 tomorrow</li>
                                    <li>Teach peak flow rate measurement.</li>
                                    <li>Decrease prednisone to 20qOD alternating with 18qOD.</li>
                                    <li>Hydrocortisone cream to finger BID.</li>
                                    <li>RTC 1 week.</li>
                                 </ul>
                              </p>
                              <p>Signed by:   Robert Dolin, MD  April 8, 2000</p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Sample_CDA_Instance"></a>7.1.2 </span><span class="title">Sample CDA Instance</span></div>
                           <div class="body">
                              <p>This is a valid and conformant CDA instance based on the sample document above. </p>
                              <blockquote><b>NOTE: </b>Readers should be aware of the evolving "Using SNOMED CT in HL7 Version 3" implementation guide, currently in a draft state.
                                 The guide, co-developed by HL7 and the College of American Pathologists, will be balloted by HL7 as an Informative Document.
                                 Recommendations in the final published guide should usurp patterns of SNOMED CT usage found in this sample instance
                              </blockquote>
                              <p><a href="SampleCDADocument.xml" target="_blank">Open the Sample File</a></p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Sample_CDA_Style_Sheet"></a>7.1.3 </span><span class="title">Sample CDA Style Sheet</span></div>
                           <div class="body">
                              <p>This is a sample CDA XSLT style sheet that can be used to transform a CDA instance into HTML. It is provided as a convenient
                                 starting point for local style sheet development, and has several known limitations, including:
                                 
                                 
                                 
                                 
                                 <ul style="margin-left:20px;">
                                    <li>Local implementations may have different requirements for rendering the CDA header.</li>
                                    <li>Does not support RegionOfInterest rendering.</li>
                                    <li>Does not support rendering of inline multimedia (e.g. multimedia that is Base 64 encoded within the CDA document).</li>
                                    <li>Does not support rendering of deleted text within the CDA Narrative Block.</li>
                                 </ul>
                              </p>
                              <p><a href="CDA.xsl" target="_blank">Open the Sample Style Sheet</a></p>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="subSubSection">
                     <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Implementation_Notes"></a>7.2 </span><span class="title">Implementation Notes</span></div>
                     <div class="body">
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Creating_CDA_Documents"></a>7.2.1 </span><span class="title">Creating CDA Documents</span></div>
                           <div class="body">
                              <p><strong>Introduction</strong></p>
                              <p>There are an ever-increasing variety of tools and techniques for creating CDA documents:
                                 
                                 
                                 <ol>
                                    <li>Transcription: most clinical documents are created through a voice interface. CDA is available as an output from transcription
                                       vendors large and small today. Some are integrating natural language processing to provide coded structures within dictated
                                       CDAs.
                                    </li>
                                    <li>EMR/EHR: many electronic medical record vendors have CDA output capability, although they provide it on-demand, not as a standard
                                       feature. For EMRs, CDA is relatively simple type of report.
                                    </li>
                                    <li>XML forms: a new generation of XML tools for forms generation can create CDA on output. </li>
                                    <li>Knowledge base: at least one major US provider has built a CDA editor on top of a knowledge base for guided, structured entry.</li>
                                    <li>Dynamic query: dynamic assembly of CDA documents is used in some distributed applications to prepopulate documents from existing
                                       data stores, such as lab result databases. This method can be used in conjunction with any of the others. 
                                       
                                       
                                    </li>
                                 </ol>
                              </p>
                              <p>This appendix considers not the specific tools and technologies, but is intended as a general guide to use of CDA in document
                                 creation.
                              </p>
                              <p><strong>Before you start: RIM compliance</strong><ul style="margin-left:20px;">
                                    <li>structures, vocabulary, datatypes</li>
                                 </ul>
                              </p>
                              <p>Creating a CDA-compliant instance, by definition, means that the information contained within is defined by the HL7 RIM. Regardless
                                 of your starting point or method of document generation, when you are done, the computable semantics of the document will
                                 derive their meaning from the relationship between RIM classes, controlled vocabulary and the V3 RIM datatypes. Any CDA-generation
                                 implementation must start with an examination of how document requirements relate to the RIM, the datatypes and vocabulary.
                                 
                              </p>
                              <p>The RIM, however, is a highly abstract model and recognizes many extensive vocabulary domains. While RIM-mapping is a necessary
                                 condition for CDA generation, it is not sufficient to determine the method of generation or to drive a user interface for
                                 document creation.
                              </p>
                              <p><strong>An exchange specification, not an authoring specification</strong><ul style="margin-left:20px;">
                                    <li>CDA is not deterministic for document creation</li>
                                 </ul>
                              </p>
                              <p>CDA is a specification for the exchange form of a clinical document. A CDA schema can validate many of the conformance requirements,
                                 but will be too general for most authoring applications. In general, standards for interoperability and broadbased exchange
                                 will not directly drive an authoring GUI. Given the extent of the CDA domain &#8211; clinical care &#8211; the requirements for generalized
                                 exchange overlap with, but don&#8217;t match, the requirements for driving an authoring interface. 
                              </p>
                              <p>For example, the CDA requirement for human readability demands that a single stylesheet render the authenticated clinical
                                 content of any CDA document. If CDA elements were defined in the generic schema that corresponds to the sections of a document,
                                 &lt;historyOfPresentIllness&gt; or &lt;Subjective&gt;, for example, a stylesheet would need to recognize each of these tags as section-level
                                 tags and render them accordingly. The CDA approach, defining &lt;section&gt; and asserting the type of section through coded vocabulary
                                 means that not only is the CDA extensible through the externally-maintained vocabulary domains, but that document designers
                                 have the flexibility to create hierarchies of sections and to name and tag them according to local requirements, while maintaining
                                 compatibility for the exchange context. Thus, while specific tagging that makes it easier to drive a GUI is fine locally,
                                 where practice can be more tightly constrained, CDA needs to take a more general approach. 
                              </p>
                              <p>Both sets of requirements, for authoring and for exchange, should be recognized. Within a defined community of interest, such
                                 as a single business enterprise, a professional society or in some cases, local and regional health authorities, there can
                                 be tight agreement on the form of a document so that the authoring definitions and the exchange definitions coincide. Unless
                                 and until there is universal agreement, there can be no universal exchange unless the diversity of local requirements is acknowledged.
                                 This is a long-winded way of saying that CDA will remain a general exchange standard, and other approaches must be available
                                 to define data entry and document creation validation requirements. 
                              </p>
                              <p>General approaches: constrain or transform
                                 
                                 
                                 <ul style="margin-left:20px;">
                                    <li>constrain: emit valid CDA directly from the authoring system using a schema that isn&#8217;t CDA </li>
                                    <li>transform: example - emit local XML, map to CDA 
                                       
                                       
                                    </li>
                                 </ul>
                              </p>
                              <p>Given that CDA is not an authoring schema, there are two logical alternatives to creating valid CDA instances. </p>
                              <p>The first is to add constraints to the CDA schema so that the resulting specification defines a particular document type (see
                                 the following exhibit "Creating a CDA through a local schema"). There are several technologies available for adding constraints.
                                 One approach is to modify the CDA schema itself to a local variant (local.cda.xsd below). Modifications could include limiting
                                 the levels of nesting; constraining vocabulary and sequence, for example requiring that a section with a LOINC code for "Subjective"
                                 initiate the document body and be followed by a section coded "Objective". These modifications could be expressed in W3C Schema
                                 or as Xpath statements within the local schema. Instances that validate against this constrained, local version of CDA are,
                                 by definition, also valid CDA instances.
                              </p>
                              <table width="90%">
                                 <tr>
                                    <td class="figure"><pre><a href="graphics/L-cda_figure3.gif" target="_blank" border="0">Link to wide graphic (opens in a new window)</a></pre></td>
                                 </tr>
                              </table>
                              <p>Templates are one type of constraint. HL7 is in the process of defining a formal template mechanism (see <a href="#The_A_in_CDA">The "A" in "CDA"
                                    			(&sect;
                                    			1.2.2 )</a>). 
                              </p>
                              <p>The second approach is to create a local schema and then transform the local XML instance to CDA </p>
                              <table width="90%">
                                 <tr>
                                    <td class="figure"><pre><a href="graphics/L-cda_figure4.gif" target="_blank" border="0">Link to wide graphic (opens in a new window)</a></pre></td>
                                 </tr>
                              </table>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="LOINC_Document_Codes"></a>7.2.2 </span><span class="title">LOINC Document Codes</span></div>
                           <div class="body">
                              <p>The following table is drawn from <a href="http://www.loinc.org/" target="_blank">LOINC, version 2.14, December 2004</a>, and equals the subset whose scale = "DOC" (and whose status &lt;&gt; "DEL"). The LOINC document model includes a component for
                                 "type of service" (conveyed in the Component field), "setting" (conveyed in the System field), "subject matter domain" (conveyed
                                 in the Method_Type field), and "training / professional level" (also conveyed in the Method_Type field). 
                              </p>
                              <p>The type of service characterizes the kind of service or activity that was provided to/for the patient (or other subject of
                                 the service) as described in the note. Common subclasses of service would be examinations, evaluations, and management.  The
                                 notion of time sequence, e.g. at the beginning (admission) at the end (discharge) and is subsumed in the axis.
                              </p>
                              <p>The setting is a modest extension of the Centers for Medicare and Medicaid Services (CMS) coarse definition of settings. Setting
                                 is not equivalent to location, which typically has more locally defined meanings.
                              </p>
                              <p>The subject matter domain characterized the subject matter or clinical categorization of a note. The training / professional
                                 level characterizes the training or professional level of the author of the document.
                              </p>
                              <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                 <caption>
                                    			Table
                                    			147: LOINC document codes
                                 </caption>
                                 <thead>
                                    <tr>
                                       <th colspan="1">LOINC_NUM</th>
                                       <th colspan="1">COMPONENT (Type of Service)</th>
                                       <th colspan="1">SYSTEM (Setting)</th>
                                       <th colspan="1"> METHOD_TYPE (Subject Matter Domain and/or Training / Professional Level)</th>
                                    </tr>
                                 </thead>
                                 <tr>
                                    <td colspan="1">
                                       <p>34862-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ADMISSION EVALUATION NOTE</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING PHYSICIAN.GENERAL MEDICINE</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34744-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ADMISSION
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34873-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ADMISSION
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34094-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ADMISSION
                                          HISTORY AND PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CARDIOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34763-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ADMISSION
                                          HISTORY AND PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28615-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>AUDIOLOGY
                                          STUDY
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>&nbsp;</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18743-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>AUTOPSY
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>33720-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>BLOOD
                                          BANK CONSULT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>&nbsp;</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34095-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>COMPREHENSIVE
                                          HISTORY &amp; PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34096-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>COMPREHENSIVE
                                          HISTORY AND PHYSICAL
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING
                                          HOME
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>&nbsp;</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34098-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONFERENCE
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34097-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONFERENCE
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING
                                          HOME
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>24611-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONFIRMATORY
                                          CONSULTATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34807-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPHTHALMOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34100-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>CRITICAL
                                          CARE UNIT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34810-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPTOMETRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34812-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OROMAXILLOFACIAL
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34814-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ORTHOPEDICS</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34831-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RADIATION
                                          ONCOLOGY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34761-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GASTROENTEROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34099-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CARDIOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34833-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RECREATIONAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34820-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHARMACY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34822-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICAL
                                          MEDICINE AND REHABILITATION
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34835-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>REHABILITATION</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34824-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34826-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PLASTIC
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34764-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34837-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RESPIRATORY
                                          
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34803-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OCCUPATIONAL
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34816-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OTORHINOLARYNGOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34783-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>KINESIOTHERAPY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34756-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34788-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34102-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34791-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34103-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PULMONARY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34795-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NEPHROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34758-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DERMATOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34760-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DIABETOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34798-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NEUROSURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34800-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NUTRITION+DIETETICS</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34749-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ANESTHESIA</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34781-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INFECTIOUS
                                          DISEASE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34828-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PODIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34101-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34104-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34785-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MENTAL
                                          
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34805-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ONCOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34797-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NEUROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34879-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ENDOCRINOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34839-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RHEUMATOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34779-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HEMATOLOGY+ONCOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34777-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GYNECOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34776-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GERONTOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34855-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OCCUPATIONAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34853-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VASCULAR
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34771-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34841-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          WORK
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34845-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SPEECH
                                          THERAPY+AUDIOLOGY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11488-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34847-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34851-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>UROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34849-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>THORACIC
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34865-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>COUNSELING
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34866-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>COUNSELING
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34872-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>COUNSELING
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          WORK
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34869-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>COUNSELING
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHARMACY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34864-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>COUNSELING
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MENTAL
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28622-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          ASSESSMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28574-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11490-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28655-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          
                                          PHYSICIAN
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18842-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34105-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>29761-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34745-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34106-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DISCHARGE
                                          
                                          
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34902-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EDUCATION
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GERONTOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34897-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EDUCATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DIABETOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34895-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EDUCATION
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34107-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EDUCATION
                                          PROCEDURE NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOME
                                          HEALTH
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34108-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34836-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>REHABILITATION</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34111-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>EMERGENCY
                                          DEPARTMENT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34834-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RECREATIONAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34759-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DERMATOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34842-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          WORK
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34113-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING
                                          HOME
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34762-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GASTROENTEROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34840-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RHEUMATOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34757-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34112-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>INPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34746-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34754-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CRITICAL
                                          CARE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34772-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34753-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CARDIOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34752-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CARDIOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34832-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RADIATION
                                          ONCOLOGY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34750-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ANESTHESIA</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34773-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          
                                          PHYSICIAN.GENERAL SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34830-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PULMONARY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34778-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GYNECOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34838-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>RESPIRATORY
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34780-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HEMATOLOGY+ONCOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34109-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34854-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VASCULAR
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34765-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34819-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PATHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34801-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NUTRITION+DIETETICS</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34823-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICAL
                                          MEDICINE AND REHABILITATION
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34825-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34827-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PLASTIC
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34829-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PODIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34846-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SPEECH
                                          THERAPY+AUDIOLOGY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34848-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34815-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ORTHOPEDICS</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34852-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>UROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34817-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OTORHINOLARYNGOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34856-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ANTICOAGULATION</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34857-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSTANCE
                                          ABUSE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34858-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PAIN
                                          
                                          MANAGEMENT
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34859-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HYPERLIPIDEMIA</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34860-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HYPERTENSION</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34861-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DIABETOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34878-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EMERGENCY
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34898-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ENDOCRINOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34905-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NEUROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34850-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>THORACIC
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34792-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34766-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34767-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MEDICAL
                                          STUDENT.GENERAL MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34768-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSE.GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34769-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          PHYSICIAN.GENERAL MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34782-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INFECTIOUS
                                          DISEASE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34784-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>KINESIOTHERAPY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34786-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MENTAL
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34821-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHARMACY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34789-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34813-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OROMAXILLOFACIAL
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34802-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OCCUPATIONAL
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34811-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPTOMETRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34808-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPHTHALMOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34806-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ONCOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34804-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OCCUPATIONAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34794-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MULTIDISCIPLINARY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34110-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DIABETOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34799-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NEUROSURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34796-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>EVALUATION
                                          AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NEPHROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34787-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GROUP
                                          COUNSELING NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MENTAL
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34790-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GROUP
                                          COUNSELING NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34843-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GROUP
                                          COUNSELING NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          WORK
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34114-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GROUP
                                          COUNSELING NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34793-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GROUP
                                          COUNSELING NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34774-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HISTORY
                                          &amp; PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28626-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HISTORY
                                          &amp; PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11492-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HISTORY
                                          &amp; PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34116-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HISTORY
                                          &amp; PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING
                                          HOME
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34115-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HISTORY
                                          &amp; PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MEDICAL
                                          STUDENT
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34117-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HISTORY
                                          AND PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18841-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL
                                          CONSULTATIONS
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>&nbsp;</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28572-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28654-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          PHYSICIAN
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18735-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18736-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18737-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PODIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18738-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18739-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          SERVICE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18734-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OCCUPATIONAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28581-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CHIROPRACTOR</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>29753-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28636-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28635-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28621-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSE
                                          PRACTITIONER
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18763-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTING
                                          PHYSICIAN
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18740-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SPEECH
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34120-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34119-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING
                                          HOME
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34118-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INITIAL
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOME
                                          HEALTH
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34121-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INTERVENTIONAL
                                          PROCEDURE NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>&nbsp;</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34896-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INTERVENTIONAL
                                          PROCEDURE NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CARDIOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34899-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>INTERVENTIONAL
                                          PROCEDURE NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GASTROENTEROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34903-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NOTE</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MENTAL
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34906-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NOTE</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PASTORAL
                                          CARE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11536-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NOTES</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34871-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPERATIVE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PODIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34874-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPERATIVE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34877-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPERATIVE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>UROLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34870-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPERATIVE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PLASTIC
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34868-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPERATIVE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ORTHOPEDICS</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34818-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPERATIVE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OTORHINOLARYNGOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34122-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PATHOLOGY
                                          PROCEDURE NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PATHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34880-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>POST-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSE.SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34875-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>POST-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34863-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>POST-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34867-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>POST-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPHTHALMOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34881-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PRE-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSE.SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34123-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PRE-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ANESTHESIA</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34775-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PRE-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          SURGERY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34876-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PRE-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGERY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34751-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PRE-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ANESTHESIA</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34809-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PRE-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OPHTHALMOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34747-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PRE-OPERATIVE
                                          EVALUATION AND MANAGEMENT NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28570-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PROCEDURE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28625-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PROCEDURE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PODIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28577-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PROCEDURE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11505-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PROCEDURE
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28575-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PROGRESS
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSE
                                          PRACTITIONER
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28580-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PROGRESS
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CHIROPRACTOR</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18744-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>STUDY
                                          
                                          REPORT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>RESPIRATORY
                                          SYSTEM
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>BRONCHOSCOPY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11510-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11508-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11509-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PODIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11506-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11507-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OCCUPATIONAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11512-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SPEECH
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>15507-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>EMERGENCY
                                          DEPARTMENT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18733-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          PHYSICIAN
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34904-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>MENTAL
                                          
                                          HEALTH
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34901-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18764-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSE
                                          PRACTITIONER
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34129-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOME
                                          HEALTH
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34132-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHARMACY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34131-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28656-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          
                                          SERVICE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34130-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOSPITAL</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28617-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34128-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34127-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTAL
                                          HYGIENIST
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34126-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>CRITICAL
                                          
                                          CARE UNIT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34900-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34125-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>HOME
                                          HEALTH CARE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>CASE
                                          
                                          MANAGER
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28569-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CONSULTING
                                          PHYSICIAN
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18762-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CHIROPRACTOR</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34124-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CARDIOLOGY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28627-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28623-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUBSEQUENT
                                          EVALUATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34133-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUMMARIZATION
                                          OF EPISODE NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34134-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUPERVISORY
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          PHYSICIAN
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34135-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUPERVISORY
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          PHYSICIAN.CARDIOLOGY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34136-2</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SUPERVISORY
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>ATTENDING
                                          PHYSICIAN.GASTROENTEROLOGY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28624-5</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGICAL
                                          OPERATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PODIATRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28573-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGICAL
                                          OPERATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>11504-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGICAL
                                          OPERATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28583-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGICAL
                                          OPERATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34137-0</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SURGICAL
                                          OPERATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34138-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TARGETED
                                          HISTORY AND PHYSICAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34139-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TELEPHONE
                                          ENCOUNTER NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34844-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TELEPHONE
                                          ENCOUNTER NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>OUTPATIENT</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          WORK
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34748-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TELEPHONE
                                          ENCOUNTER NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34140-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TRANSFER
                                          OF CARE REFERRAL NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34770-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TRANSFER
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>GENERAL
                                          MEDICINE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>18761-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TRANSFER
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>{PROVIDER}</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28651-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TRANSFER
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>NURSING</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28616-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TRANSFER
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>34755-9</p>
                                    </td>
                                    <td colspan="1">
                                       <p>TRANSFER
                                          SUMMARIZATION NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>CRITICAL
                                          
                                          CARE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28568-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VISIT
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>EMERGENCY
                                          DEPARTMENT
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICIAN</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28653-4</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VISIT
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SOCIAL
                                          SERVICE
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28618-7</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VISIT
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>DENTISTRY</p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28579-1</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VISIT
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PHYSICAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28578-3</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VISIT
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>OCCUPATIONAL
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28571-8</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VISIT
                                          
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>SPEECH
                                          THERAPY
                                       </p>
                                    </td>
                                 </tr>
                                 <tr>
                                    <td colspan="1">
                                       <p>28628-6</p>
                                    </td>
                                    <td colspan="1">
                                       <p>VISIT
                                          NOTE
                                       </p>
                                    </td>
                                    <td colspan="1">
                                       <p>{SETTING}</p>
                                    </td>
                                    <td colspan="1">
                                       <p>PSYCHIATRY</p>
                                    </td>
                                 </tr>
                              </table>
                              <p></p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_and_Semantic_Interoperability"></a>7.2.3 </span><span class="title">CDA and Semantic Interoperability</span></div>
                           <div class="body">
                              <p>A long term objective of CDA and other specifications in the V3 family is to achieve increasingly greater and greater "semantic
                                 interoperability", which might be defined as the ability of two applications to share data, with no prior negotiations, such
                                 that decision support within each application continues to function reliably when processed against the received data.
                              </p>
                              <p>CDA seeks to achieve the highest level of constraint that can exist in an international standard. Where international consensus
                                 is lacking, and where uses cases in different realms currently preclude consensus, CDA will need to be necessarily inclusive.
                                 In such areas, ongoing harmonization and consensus building will further enable semantic interopability, which will be reflected
                                 in future iterations of CDA. 
                              </p>
                              <p>While the framework provided by the RIM and by CDA and by the shared HL7 Clinical Statement Model are a critical component
                                 of semantic interoperability, they are not currently sufficient, particularly given the lack of global terminology solution,
                                 and the fact that each terminology overlaps with the RIM in different ways. Such terminology solutions are outside the scope
                                 of CDA, and will need to be addressed in various national and international forums.
                              </p>
                           </div>
                        </div>
                        <div class="subSubSubSection">
                           <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Enumeration_of_Changes_Between_Release_One_and_Release_Two"></a>7.2.4 </span><span class="title">Changes from CDA Release 1</span></div>
                           <div class="body">
                              <p>CDA, Release One became an ANSI-approved HL7 Standard in November, 2000, representing the first specification derived from
                                 the HL7 Reference Information Model (RIM). Since then, the RIM has matured, as has the methodology used to derive RIM-based
                                 specifications. In addition, early adopters are posing new use cases for incorporation. 
                              </p>
                              <p>The basic model of CDA, Release Two is essentially unchanged. A CDA document has a header and a body. The body contains nested
                                 sections. These sections can be coded using standard vocabularies, and can contain "entries". CDA, Release One entries included
                                 such things as character data, hyperlinks, and multimedia. 
                              </p>
                              <p>The main evolutionary steps in CDA, Release Two are that both header and body are fully RIM-derived, and there is a much richer
                                 assortment of entries to use within CDA sections. CDA, Release Two enables clinical content to be formally expressed to the
                                 extent that is it modeled in the RIM.
                              </p>
                              <p>CDA, Release Two takes advantage of HL7&#8217;s growing expertise in creating model-based XML standards. Given the evolution of
                                 the RIM and the HL7 development methodology since November 2000, there are a number of changes between the new and the old
                                 CDA. 
                              </p>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="Deprecated_Components"></a>7.2.4.1 </span><span class="title">Deprecated Components</span></div>
                                 <div class="body">
                                    <p>The following components are retained for backwards compatibility with CDA, Release One, and have been deprecated: 
                                       
                                       
                                       <ul style="margin-left:20px;">
                                          <li>ClinicalDocument/copyTime.</li>
                                          <li>ClinicalDocument/authenticator/signatureCode/@code="X".</li>
                                          <li>ClinicalDocument/legalAuthenticator/signatureCode/@code="X".</li>
                                          <li>ClinicalDocument/assignedAuthor/assignedAuthoringDevice/MaintainedEntity.
                                             
                                          </li>
                                          <li>ClinicalDocument/recordTarget/patientRole/patient/id.</li>
                                          <li>linkHtml.name.</li>
                                          <li>table.border, table.cellspacing, table.cellpadding.</li>
                                       </ul>
                                    </p>
                                    <p>Further use of these components is discouraged.
                                       
                                       
                                       				
                                    </p>
                                 </div>
                              </div>
                              <div class="subSubSubSection">
                                 <div class="header"><span class="icon">&nbsp;</span><span class="number"><a name="CDA_Header_Changes"></a>7.2.4.2 </span><span class="title">CDA R1 to CDA R2 Correspondence</span></div>
                                 <div class="body">
                                    <p>The following tables enumerate CDA R1 components and show the corresponding components in CDA R2. In some cases, such as where
                                       CDA R1 was ambiguous or where a CDA R1 participant was split into multiple CDA R2 participants, a formal mapping might need
                                       to take local usage into account. In such cases guidance is provided rather than formal rules.
                                    </p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			148: CDA R1 to CDA R2 Vocabulary Correspondence
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">CDA R1 vocabulary</th>
                                             <th colspan="1">Corresponding CDA R2 vocabulary</th>
                                             <th colspan="1">Comments</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / document_type_cd &lt;= DocumentType (2.16.840.1.113883.6.1.10870) (CWE)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / code &lt;= DocumentType (2.16.840.1.113883.6.1) (CWE)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / confidentiality_cd &lt;= ServiceConfidentiality
                                                (2.16.840.1.113883.5.10228) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / confidentialityCode &lt;= x_BasicConfidentialityKind (2.16.840.1.113883.5.25) (CWE)</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Removed "C", "D", "I", "S", "T" from value set.</li>
                                                <li>Added "V" to value set.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / document_relationship / document_relationship.type_cd &lt;= ServiceRelationship
                                                (2.16.840.1.113883.5.10317) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / relatedDocument / @typeCode &lt;= x_ActRelationshipDocument
                                                (2.16.840.1.113883.5.1002) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Added "XFRM" to value set.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / fulfills_order / fulfills_order.type_cd &lt;= ServiceRelationship
                                                (2.16.840.1.113883.5.10317) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / inFulfillmentOf / @typeCode &lt;= FLFS
                                                (2.16.840.1.113883.5.1002) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>No change in value set.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / patient_encounter / practice_setting_cd &lt;= PracticeSetting
                                                (2.16.840.1.113883.5.10588) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / componentOf / encompassingEncounter / location / healthCareFacility / code &lt;= ServiceDeliveryLocationRoleType
                                                (2.16.840.1.113883.5.111) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / authenticator / authenticator.type_cd &lt;= ServiceActor
                                                (2.16.840.1.113883.5.10246) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / authenticator / @typeCode &lt;= AUTHEN
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Fixed value changed from "VRF" to "AUTHEN".</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / authenticator / signature_cd &lt;= ServiceActorSignature
                                                (2.16.840.1.113883.5.10282) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / authenticator / signatureCode &lt;= ParticipationSignature
                                                (2.16.840.1.113883.5.89) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Value of "X" has been deprecated.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / authenticator / person / person_name / person_name.type_cd &lt;= PersonNamePurpose
                                                (2.16.840.1.113883.5.200) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / authenticator / assignedEntity / assignedPerson / name / @use &lt;= PersonNameUse
                                                (2.16.840.1.113883.5.45) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Vocabulary domain has changed from CWE to CNE. The CDA R2 value set includes enumerated CDA R1 values ("A", "C", "I", "L",
                                                   "R"). CDA R1 to CDA R2 translations may require local markup where the CDA R1 value set was extended.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / legal_authenticator / authenticator.type_cd &lt;= ServiceActor
                                                (2.16.840.1.113883.5.10246) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / legalAuthenticator / @typeCode &lt;= LA
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Fixed value changed from "SPV" to "AUTHEN".</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / legal_authenticator / signature_cd &lt;= ServiceActorSignature
                                                (2.16.840.1.113883.5.10282) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / legalAuthenticator / signatureCode &lt;= ParticipationSignature
                                                (2.16.840.1.113883.5.89) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Value of "X" has been deprecated.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / intended_recipient / intended_recipient.type_cd &lt;= ServiceActor
                                                (2.16.840.1.113883.5.10246) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / intendedRecipient / @typeCode &lt;= x_InformationRecipient
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Added "PRCP" to value set.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / originator / originator.type_cd &lt;= ServiceActor
                                                (2.16.840.1.113883.5.10246) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / author / @typeCode &lt;= AUT
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>No change to value set.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / originating_organization / originating_organization.type_cd &lt;= ServiceActor
                                                (2.16.840.1.113883.5.10246) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / custodian / @typeCode &lt;= CST
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>No change to value set.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / transcriptionist / transcriptionist.type_cd &lt;= ServiceActor (2.16.840.1.113883.5.10246) (CNE)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / dataEnterer / @typeCode &lt;= ENT
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>No change to value set.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / provider / provider.type_cd &lt;= ServiceActor (2.16.840.1.113883.5.10246) (CNE) (Value set "ASS",
                                                "CON", "PRF")
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / serviceEvent / performer / @typeCode &lt;= x_ServiceEventPerformer
                                                (2.16.840.1.113883.5.90) (CNE) (Value set "PRF", "PPRF", "SPRF")
                                             </p>
                                             <p>ClinicalDocument / encompassingEncounter / responsibleParty / @typeCode &lt;= RESP (2.16.840.1.113883.5.90) (CNE)</p>
                                             <p>ClinicalDocument / encompassingEncounter / encounterParticipant / @typeCode &lt;= x_EncounterParticipant (2.16.840.1.113883.5.90)
                                                (CNE) (Value set "ADM", "ATND", "CON" , "DIS" , "REF")
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>CDA R1 provider has been split into three distinct participants. Local use of CDA R1 can be used to determine the exact correspondence.</li>
                                                <li>CDA R1 value "ASS" correlates with CDA R2 value "SPRF".</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / provider / function_cd &lt;= ServiceActorFunction
                                                (2.16.840.1.113883.5.10267) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / serviceEvent / performer / functionCode &lt;= ParticipationFunction
                                                (2.16.840.1.113883.5.88) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / service_actor / service_actor.type_cd &lt;= ServiceActor
                                                (2.16.840.1.113883.5.10246) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / participant / @typeCode &lt;= ParticipationType
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Vocabulary domain has changed from CWE to CNE. CDA R1 to CDA R2 translations may require local markup where the CDA R1 value
                                                   set was extended.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / service_actor / signature_cd &lt;= ServiceActorSignature
                                                (2.16.840.1.113883.5.10282) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / authenticator / signatureCode &lt;= ParticipationSignature
                                                (2.16.840.1.113883.5.89) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Value of "X" has been deprecated.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / patient / administrative_gender_cd &lt;= AdministrativeGender (2.16.840.1.113883.5.1) (CWE)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / recordTarget / patientRole / patient / administrativeGenderCode &lt;= AdministrativeGender
                                                (2.16.840.1.113883.5.1) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / originating_device / originating_device.type_cd &lt;= ServiceTargetType
                                                (2.16.840.1.113883.5.10285) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / author / @typeCode &lt;= AUT
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>CDA R1 "ODV" maps to CDA R2 "AUT".</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / originating_device / device / responsibility / responsibility.type_cd &lt;= MaterialResponsibility
                                                (2.16.840.1.113883.5.10416) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / author / assignedAuthor / assignedAuthoringDevice / asMaintainedEntity / @classCode &lt;= MNT
                                                (2.16.840.1.113883.5.110) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Vocabulary domain has changed from CWE to CNE. The CDA R2 value set includes enumerated CDA R1 values ("MNT"). CDA R1 to CDA
                                                   R2 translations may require local markup where the CDA R1 value set was extended.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / service_target / service_target.type_cd &lt;= ServiceTargetType (2.16.840.1.113883.5.10285) (CWE)</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / participant / @typeCode &lt;= ParticipationType
                                                (2.16.840.1.113883.5.90) (CNE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Vocabulary domain has changed from CWE to CNE. CDA R1 to CDA R2 translations may require local markup where the CDA R1 value
                                                   set was extended.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>section / caption / caption_cd (CWE) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / code &lt;= DocumentSectionType
                                                (2.16.840.1.113883.6.1) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>See also caption/caption_cd in the next row. The caption of a section corresponds to CDA R2 differently than other captions.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>caption / caption_cd (CWE) </p>
                                          </td>
                                          <td colspan="1">
                                             <p>@styleCode &lt;= StyleType
                                                (2.16.840.1.113883.19.5.1) (CWE)
                                             </p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>See also section/caption/caption_cd in the row above. The caption of a section corresponds to CDA R2 differently than other
                                                   captions.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			149: CDA R1 to CDA R2 Header Correspondence
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">CDA R1 component</th>
                                             <th colspan="1">Corresponding CDA R2 component</th>
                                             <th colspan="1">Comments</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>levelone</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>levelone / clinical_document_header</p>
                                          </td>
                                          <td colspan="1">
                                             <p>NOT PRESENT</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Wrapping header tag no longer present.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / set_id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / setId</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / version_nbr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / versionNumber</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / document_type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / code</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / service_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / documentationOf / serviceEvent / effectiveTime</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The GTS data type in CDA R1 has been constrained to a time interval in CDA R2. Local markup can be used where it is necessary
                                                   to convey additional complexity.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / origination_dttm</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / effectiveTime</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / copy_dttm</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / copyTime</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / confidentiality_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / confidentialityCode</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Cardinality changed from [0..*] to [0..1]. CDA R1 expressed all confidentiality flags in the header, which were then referenced
                                                   from within the body. CDA R2 expresses confidentiality in the header, and allows it to be overridden in the body.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / document_relationship</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / relatedDocument</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>document_relationship / document_relationship.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>relatedDocument / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>document_relationship / related_document</p>
                                          </td>
                                          <td colspan="1">
                                             <p>relatedDocument / parentDocument</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>document_relationship / related_document / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>relatedDocument / parentDocument / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>document_relationship / related_document / set_id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>relatedDocument / parentDocument / setId</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>document_relationship / related_document / version_nbr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>relatedDocument / parentDocument / versionNumber</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / fulfills_order</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / inFulfillmentOf</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>fulfills_order / fulfills_order.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>inFulfillmentOf / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>fulfills_order / order</p>
                                          </td>
                                          <td colspan="1">
                                             <p>inFulfillmentOf / order</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>fulfills_order / order / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>inFulfillmentOf / order / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / patient_encounter</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / componentOf / encompassingEncounter</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient_encounter / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>encompassingEncounter / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient_encounter / practice_setting_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>encompassingEncounter / location / healthCareFacility / code</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient_encounter / encounter_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>encompassingEncounter / effectiveTime</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient_encounter / service_location</p>
                                          </td>
                                          <td colspan="1">
                                             <p>encompassingEncounter / location / healthCareFacility</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient_encounter / service_location / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>encompassingEncounter / location / healthCareFacility / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient_encounter / service_location / addr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>encompassingEncounter / location / healthCareFacility / location / addr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / authenticator</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / authenticator</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The time interval data type in CDA R1 has been constrained to a point in time in CDA R2. Local markup can be used where it
                                                   is necessary to convey additional complexity.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / authenticator.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / time</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / signature_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / signatureCode</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>CDA R1 represented either an intended (signature code "X") or actual (signature code "S") authenticator. CDA R2 only represents
                                                   an actual authenticator, so has deprecated the value of "X".
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / assignedPerson</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / id </p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person / person_name</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / assignedPerson / name</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person / person_name / effective_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / assignedPerson / name / validTime</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person / person_name / nm</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / assignedPerson / name</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person / person_name / person_name.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / assignedPerson / name / @use</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person / addr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / addr / </p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>authenticator / person / telecom</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / assignedEntity / telecom</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / legal_authenticator</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / legalAuthenticator</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>legal_authenticator / legal_authenticator.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>legalAuthenticator / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>legal_authenticator / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>legalAuthenticator / time</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The time interval data type in CDA R1 has been constrained to a point in time in CDA R2. Local markup can be used where it
                                                   is necessary to convey additional complexity.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>legal_authenticator / signature_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>legalAuthenticator / signatureCode</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>CDA R1 represented either an intended (signature code "X") or actual (signature code "S") legal authenticator. CDA R2 only
                                                   represents an actual legal authenticator, so has deprecated the value of "X".
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>legal_authenticator / person</p>
                                          </td>
                                          <td colspan="1">
                                             <p>legalAuthenticator / assignedEntity / assignedPerson</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / intended_recipient </p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / intendedRecipient</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>intended_recipient / intended_recipient.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>intendedRecipient / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / originator</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / author</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originator / originator.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originator / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / time</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The time interval data type in CDA R1 has been constrained to a point in time in CDA R2. Local markup can be used where it
                                                   is necessary to convey additional complexity.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / originating_organization</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / author</p>
                                             <p>ClinicalDocument / custodian</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The CDA R1 originating_organization corresponds to the scoper of the author AND the custodian organization, because it served
                                                   both purposes in R1.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_organization / originating_organization.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>custodian / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_organization / organization</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / representedOrganization</p>
                                             <p>custodian / assignedCustodian / representedCustodianOrganization</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_organization / organization / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / representedOrganization / id</p>
                                             <p>custodian / assignedCustodian / representedCustodianOrganization / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_organization / organization / organization.nm</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / representedOrganization / name</p>
                                             <p>custodian / assignedCustodian / representedCustodianOrganization / name</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_organization / organization / addr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / representedOrganization / addr</p>
                                             <p>custodian / assignedCustodian / representedCustodianOrganization / addr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / transcriptionist</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / dataEnterer</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>transcriptionist / transcriptionist.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>dataEnterer / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>transcriptionist / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>dataEnterer / time</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The time interval data type in CDA R1 has been constrained to a point in time in CDA R2. Local markup can be used where it
                                                   is necessary to convey additional complexity.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / provider</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / serviceEvent / performer</p>
                                             <p>ClinicalDocument / encompassingEncounter / responsibleParty</p>
                                             <p>ClinicalDocument / encompassingEncounter / encounterParticipant</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>CDA R1 provider has been split into three distinct participants. Local use of CDA R1 can be used to determine the exact correspondence.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / service_actor</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / participant</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Alternatively, could correspond to one of the new more specific participants (e.g. informant, performer, responsibleParty,
                                                   encounterParticipant) depending on local use.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>service_actor / service_actor.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>participant / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>service_actor / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>participant / time</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>service_actor / signature_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>authenticator / signatureCode</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Local use of CDA R1 can determine whether service actor signatures can be reflected as additional CDA R2 authenticators.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / patient</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / recordTarget</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / patient.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>NOT PRESENT</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Local markup can be used to accommodate mapping if necessary.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / person</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole / patient</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / person / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole / patient / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / is_known_by</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / is_known_by / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / is_known_by / is_known_to</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole / providerOrganization</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>CDA R1 allows for multiple is_known_by relationships, each with its own is_known_to relationship. CDA R2 has a single providerOrganization.
                                                   Where CDA R1 has listed multiple organizations, the one that is also the custodian organization corresponds to providerOrganization.
                                                   Other values can be modeled using local markup.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / is_known_by / is_known_to / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole / providerOrganization / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / birth_dttm</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole / patient / birthTime</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>patient / administrative_gender_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>recordTarget / patientRole / patient / administrativeGenderCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / originating_device</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / author</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_device / originating_device.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_device / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / time</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The time interval data type in CDA R1 has been constrained to a point in time in CDA R2. Local markup can be used where it
                                                   is necessary to convey additional complexity.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_device / device</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_device / device / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_device / device / responsibility</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / assignedAuthoringDevice / asMaintainedEntity</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_device / device / responsibility / responsibility.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / assignedAuthoringDevice / asMaintainedEntity / @classCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>originating_device / device / responsibility / responsibility_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>author / assignedAuthor / assignedAuthoringDevice / asMaintainedEntity / effectiveTime</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>clinical_document_header / service_target</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / participant</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Alternatively, could correspond to one of the new more specific participants (e.g. informant, performer, responsibleParty,
                                                   encounterParticipant) depending on local use.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>service_target / service_target.type_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>participant / @typeCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>service_target / participation_tmr</p>
                                          </td>
                                          <td colspan="1">
                                             <p>participant / time</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                    <table width="90%" cellspacing="0" cellpadding="5" border="1" bordercolor="blue">
                                       <caption>
                                          			Table
                                          			150: CDA R1 to CDA R2 Body Correspondence
                                       </caption>
                                       <thead>
                                          <tr>
                                             <th colspan="1">CDA R1 component</th>
                                             <th colspan="1">Corresponding CDA R2 component</th>
                                             <th colspan="1">Comments</th>
                                          </tr>
                                       </thead>
                                       <tr>
                                          <td colspan="1">
                                             <p>levelone / body / non_xml</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / component / nonXMLBody</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>levelone / body / section</p>
                                          </td>
                                          <td colspan="1">
                                             <p>ClinicalDocument / component / structuredBody / section</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>section / @originator</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / author</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>In CDA R1, all authors are listed in the header, and then referenced from the body. In CDA R2, authors listed in the header
                                                   propagate to the body where they can be overridden (as described in "CDA Context").
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>section / @confidentiality</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / confidentialityCode</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>In CDA R1, all confidentiality values are listed in the header, and then referenced from the body. In CDA R2, confidentiality
                                                   listed in the header propagates to the body where it can be overridden (as described in "CDA Context").
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>section / @xml:lang</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / languageCode</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>section / caption</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / title</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>section / caption / link</p>
                                          </td>
                                          <td colspan="1">
                                             <p>NOT PRESENT</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Local use can determine whether to map to linkHtml in the narrative block of CDA R2.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>section / caption / caption_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / code</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>See also caption/caption_cd in the row below. The caption of a section corresponds to CDA R2 differently than other captions.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>@originator</p>
                                          </td>
                                          <td colspan="1">
                                             <p>SEE COMMENTS</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>In CDA R2, section authorship applies to the narrative block. Nested entries with an associated author participant can reference
                                                   into the narrative block where it is necessary to ascribe authorship to a particular statement.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>@confidentiality</p>
                                          </td>
                                          <td colspan="1">
                                             <p>NOT PRESENT</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Confidentiality cannot be ascribed below the section level.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>@xml:lang</p>
                                          </td>
                                          <td colspan="1">
                                             <p>@language</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The language attribute functions as it did in CDA R1.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>content</p>
                                          </td>
                                          <td colspan="1">
                                             <p>content</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>link</p>
                                          </td>
                                          <td colspan="1">
                                             <p>linkHtml</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>The CDA R1 link tag no longer exists. It had a required child element, link_html, which corresponds to CDA R2 linkHtml.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>coded_entry</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / entry / act</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>coded_entry / coded_entry.id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / entry / act / id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>coded_entry / coded_entry.value</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / entry / act / code</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>observation_media</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / entry / observationMedia</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Use the renderMultiMedia tag in the narrative block to reference an observationMedia entry.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>observation_media / observation_media.id</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / entry / observationMedia / id</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li></li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>observation_media / observation_media.value</p>
                                          </td>
                                          <td colspan="1">
                                             <p>section / entry / observationMedia / value</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li></li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>local_markup</p>
                                          </td>
                                          <td colspan="1">
                                             <p>SEE COMMENTS</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>Local markup is precluded from use in the CDA R2 narrative block particularly if they would interfere with the ability of
                                                   those not recognizing the markup to properly render the document. Foreign namespace extensions can be used outside the narrative
                                                   block (as described in "CDA Extensibility").
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>caption</p>
                                          </td>
                                          <td colspan="1">
                                             <p>caption</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>caption / caption_cd</p>
                                          </td>
                                          <td colspan="1">
                                             <p>@styleCode</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>See also section/caption/caption_cd in the row above. The caption of a section corresponds to CDA R2 differently than other
                                                   captions.
                                                </li>
                                             </ul>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>paragraph</p>
                                          </td>
                                          <td colspan="1">
                                             <p>paragraph</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>list</p>
                                          </td>
                                          <td colspan="1">
                                             <p>list</p>
                                          </td>
                                          <td colspan="1">
                                             <p>&nbsp;</p>
                                          </td>
                                       </tr>
                                       <tr>
                                          <td colspan="1">
                                             <p>table</p>
                                          </td>
                                          <td colspan="1">
                                             <p>table</p>
                                          </td>
                                          <td colspan="1">
                                             <ul>
                                                <li>CDA R2 table content model no longer contains a "tr" element. This element is now wrapped in a "tbody" element.</li>
                                             </ul>
                                          </td>
                                       </tr>
                                    </table>
                                    <p></p>
                                 </div>
                              </div>
                           </div>
                        </div>
                     </div>
                  </div>
               </div>
            </div>
         </div>
         <p>
            <table>
               <tbody>
                  <tr>
                     <td>
                        <div id="csslinks"><a href="#" name="v3mviewedits" onclick="setActiveStyleSheet('v3mviewedits'); return false;">View Revision Marks</a><a href="#" name="v3m" onclick="setActiveStyleSheet('v3m'); return false;">Hide Revision Marks</a></div>
                     </td>
                     <td><a class="custombutton" href="#top">Return to top of page</a></td>
                  </tr>
               </tbody>
            </table>
         </p>
      </div>
   </body>
</html>